- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $144.54 / $2,089.30 / $3,715.35
| Facility | | $144.54 | $2,089.30 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.20 / $186.21 / $537.03
| Professional | | $112.20 | $186.21 | $537.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $281.84 / $1,621.81 / $19,498.45
| Facility | | $281.84 | $1,621.81 | $19,498.45 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $1,230.27 / $1,230.27 / $1,230.27
| Facility | 52 | $1,230.27 | $1,230.27 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.89 / $223.87 / $524.81
| Professional | | $125.89 | $223.87 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $134.90 / $134.90 / $309.03
| Facility | | $134.90 | $134.90 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.53 / $295.12 / $467.74
| Professional | | $199.53 | $295.12 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $275.42 / $524.81
| Professional | | $162.18 | $275.42 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $104.71 / $380.19 / $7,079.46
| Facility | | $104.71 | $380.19 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $257.04 / $416.87
| Professional | | $204.17 | $257.04 | $416.87 |
- 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
- $123.03 / $218.78 / $446.68
| Professional | | $123.03 | $218.78 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $281.84 / $1,621.81 / $19,498.45
| Facility | | $281.84 | $1,621.81 | $19,498.45 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $1,230.27 / $1,230.27 / $1,230.27
| Facility | 52 | $1,230.27 | $1,230.27 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.89 / $223.87 / $512.86
| Professional | | $125.89 | $223.87 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $1,862.09 / $2,818.38
| Facility | | $630.96 | $1,862.09 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $239.88 / $478.63
| Professional | | $144.54 | $239.88 | $478.63 |