- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $2,187.76 / $3,801.89
| Facility | | $302.00 | $2,187.76 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $338.84 / $831.76
| Professional | | $275.42 | $338.84 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $1,023.29 / $19,498.45
| Facility | | $467.74 | $1,023.29 | $19,498.45 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $1,318.26 / $1,318.26 / $1,318.26
| Facility | 54 | $1,318.26 | $1,318.26 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $457.09 / $1,174.90
| Professional | | $269.15 | $457.09 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $371.54 / $851.14
| Facility | | $371.54 | $371.54 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $630.96 / $954.99
| Professional | | $371.54 | $630.96 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $512.86 / $912.01
| Professional | | $316.23 | $512.86 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $707.95 / $7,079.46
| Facility | | $323.59 | $707.95 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $549.54 / $691.83
| Professional | | $446.68 | $549.54 | $691.83 |
- 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
- $380.19 / $602.56 / $1,000.00
| Professional | | $380.19 | $602.56 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $1,023.29 / $19,498.45
| Facility | | $467.74 | $1,023.29 | $19,498.45 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $1,318.26 / $1,318.26 / $1,318.26
| Facility | 54 | $1,318.26 | $1,318.26 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $457.09 / $1,174.90
| Professional | | $269.15 | $457.09 | $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
- $309.03 / $478.63 / $977.24
| Professional | | $309.03 | $478.63 | $977.24 |