- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $2,238.72 / $3,801.89
| Facility | | $436.52 | $2,238.72 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $512.86 / $1,258.93
| Professional | | $436.52 | $512.86 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $1,230.27 / $19,498.45
| Facility | | $467.74 | $1,230.27 | $19,498.45 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $2,089.30 / $2,089.30 / $2,089.30
| Facility | 54 | $2,089.30 | $2,089.30 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $691.83 / $1,698.24
| Professional | | $426.58 | $691.83 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $588.84 / $1,348.96
| Facility | | $588.84 | $588.84 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $1,000.00 / $1,348.96
| Professional | | $588.84 | $1,000.00 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $741.31 / $1,380.38
| Professional | | $478.63 | $741.31 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.19 / $1,047.13 / $7,079.46
| Facility | | $380.19 | $1,047.13 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.60 / $758.58 / $1,023.29
| Professional | | $616.60 | $758.58 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $2,041.74 / $3,467.37
| Facility | | $630.96 | $2,041.74 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $891.25 / $1,412.54
| Professional | | $549.54 | $891.25 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $1,230.27 / $19,498.45
| Facility | | $501.19 | $1,230.27 | $19,498.45 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $2,089.30 / $2,089.30 / $2,089.30
| Facility | 54 | $2,089.30 | $2,089.30 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $691.83 / $1,698.24
| Professional | | $436.52 | $691.83 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $1,819.70 / $2,818.38
| Facility | | $501.19 | $1,819.70 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $724.44 / $1,445.44
| Professional | | $489.78 | $724.44 | $1,445.44 |