- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $478.63 / $2,238.72 / $3,801.89
| Facility | | $478.63 | $2,238.72 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $549.54 / $1,445.44
| Professional | | $446.68 | $549.54 | $1,445.44 |
- 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
- $2,137.96 / $2,137.96 / $2,137.96
| Facility | 54 | $2,137.96 | $2,137.96 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $741.31 / $1,778.28
| Professional | | $446.68 | $741.31 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $575.44 / $1,318.26
| Facility | | $575.44 | $575.44 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.60 / $1,000.00 / $1,445.44
| Professional | | $616.60 | $1,000.00 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $794.33 / $1,412.54
| Professional | | $501.19 | $794.33 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.19 / $1,023.29 / $7,079.46
| Facility | | $380.19 | $1,023.29 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.69 / $812.83 / $1,096.48
| Professional | | $660.69 | $812.83 | $1,096.48 |
- 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
- $562.34 / $891.25 / $1,479.11
| Professional | | $562.34 | $891.25 | $1,479.11 |
- 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
- $2,137.96 / $2,137.96 / $2,137.96
| Facility | 54 | $2,137.96 | $2,137.96 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $741.31 / $1,778.28
| Professional | | $457.09 | $741.31 | $1,778.28 |
- 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
- $501.19 / $758.58 / $1,513.56
| Professional | | $501.19 | $758.58 | $1,513.56 |