- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $3,630.78 / $6,456.54
| Facility | | $2,570.40 | $3,630.78 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.69 / $954.99 / $1,621.81
| Professional | | $660.69 | $954.99 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $3,890.45 / $11,748.98
| Facility | | $56.23 | $3,890.45 | $11,748.98 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $8,317.64 / $8,317.64 / $8,317.64
| Facility | 54 | $8,317.64 | $8,317.64 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $1,258.93 / $3,548.13
| Professional | | $602.56 | $1,258.93 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.31 / $1,258.93 / $1,698.24
| Professional | | $741.31 | $1,258.93 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.23 / $2,754.23 / $2,754.23
| Facility | | $2,754.23 | $2,754.23 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.33 / $1,318.26 / $2,398.83
| Professional | | $794.33 | $1,318.26 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $1,202.26 / $7,079.46
| Facility | | $549.54 | $1,202.26 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.60 / $776.25 / $1,071.52
| Professional | | $616.60 | $776.25 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $5,888.44 / $13,182.57
| Facility | | $2,344.23 | $5,888.44 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $1,047.13 / $1,862.09
| Professional | | $645.65 | $1,047.13 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $275.42 / $275.42
| Professional | | $275.42 | $275.42 | $275.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $3,890.45 / $11,748.98
| Facility | | $56.23 | $3,890.45 | $11,748.98 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $8,317.64 / $8,317.64 / $8,317.64
| Facility | 54 | $8,317.64 | $8,317.64 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.96 / $1,258.93 / $2,884.03
| Professional | | $630.96 | $1,258.93 | $2,884.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $5,888.44 / $13,182.57
| Facility | | $2,344.23 | $5,888.44 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.33 / $1,318.26 / $2,041.74
| Professional | | $794.33 | $1,318.26 | $2,041.74 |