- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $239.88 / $2,089.30 / $3,715.35
| Facility | | $239.88 | $2,089.30 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $281.84 / $707.95
| Professional | | $213.80 | $281.84 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $1,000.00 / $19,498.45
| Facility | | $467.74 | $1,000.00 | $19,498.45 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $1,023.29 / $1,023.29 / $1,023.29
| Facility | 54 | $1,023.29 | $1,023.29 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $354.81 / $870.96
| Professional | | $213.80 | $354.81 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $288.40 / $288.40 / $660.69
| Facility | | $288.40 | $288.40 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $467.74 / $660.69
| Professional | | $288.40 | $467.74 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $389.05 / $691.83
| Professional | | $245.47 | $389.05 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $245.47 / $524.81 / $7,079.46
| Facility | | $245.47 | $524.81 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $389.05 / $537.03
| Professional | | $316.23 | $389.05 | $537.03 |
- 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
- $275.42 / $457.09 / $707.95
| Professional | | $275.42 | $457.09 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $263.03 / $263.03 / $263.03
| Facility | | $263.03 | $263.03 | $263.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $1,000.00 / $19,498.45
| Facility | | $467.74 | $1,000.00 | $19,498.45 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $1,023.29 / $1,023.29 / $1,023.29
| Facility | 54 | $1,023.29 | $1,023.29 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $354.81 / $870.96
| Professional | | $218.78 | $354.81 | $870.96 |
- 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
- $245.47 / $371.54 / $724.44
| Professional | | $245.47 | $371.54 | $724.44 |