- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $281.84 / $2,187.76 / $3,801.89
| Facility | | $281.84 | $2,187.76 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $363.08 / $891.25
| Professional | | $288.40 | $363.08 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $1,047.13 / $19,498.45
| Facility | | $467.74 | $1,047.13 | $19,498.45 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $1,380.38 / $1,380.38 / $1,380.38
| Facility | 54 | $1,380.38 | $1,380.38 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $467.74 / $1,174.90
| Professional | | $281.84 | $467.74 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $389.05 / $389.05 / $891.25
| Facility | | $389.05 | $389.05 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $269.15 / $269.15 / $616.60
| Facility | 54 | $269.15 | $269.15 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $645.65 / $933.25
| Professional | | $389.05 | $645.65 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $524.81 / $954.99
| Professional | | $331.13 | $524.81 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.13 / $724.44 / $7,079.46
| Facility | | $331.13 | $724.44 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $549.54 / $724.44
| Professional | | $446.68 | $549.54 | $724.44 |
- 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
- $389.05 / $616.60 / $1,000.00
| Professional | | $389.05 | $616.60 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $1,047.13 / $19,498.45
| Facility | | $467.74 | $1,047.13 | $19,498.45 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $1,380.38 / $1,380.38 / $1,380.38
| Facility | 54 | $1,380.38 | $1,380.38 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $467.74 / $1,174.90
| Professional | | $281.84 | $467.74 | $1,174.90 |
- 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
- $316.23 / $489.78 / $1,000.00
| Professional | | $316.23 | $489.78 | $1,000.00 |