- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $2,570.40 / $3,715.35
| Facility | | $537.03 | $2,570.40 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $501.19 / $2,290.87
| Professional | | $147.91 | $501.19 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $2,344.23 / $4,677.35
| Facility | | $56.23 | $2,344.23 | $4,677.35 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $794.33 / $794.33 / $794.33
| Facility | 53 | $794.33 | $794.33 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $467.74 / $1,445.44
| Professional | | $169.82 | $467.74 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $181.97 / $181.97 / $426.58
| Facility | | $181.97 | $181.97 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $602.56 / $1,288.25
| Professional | | $269.15 | $602.56 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $588.84 / $1,698.24
| Professional | | $234.42 | $588.84 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $141.25 / $501.19 / $7,079.46
| Facility | | $141.25 | $501.19 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $724.44 / $1,348.96
| Professional | | $575.44 | $724.44 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $3,630.78 / $8,511.38
| Facility | | $1,698.24 | $3,630.78 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $489.78 / $1,230.27
| Professional | | $165.96 | $489.78 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,174.90 / $2,754.23 / $4,570.88
| Facility | | $1,174.90 | $2,754.23 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $331.13 / $1,047.13
| Professional | | $331.13 | $331.13 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $2,344.23 / $4,677.35
| Facility | | $56.23 | $2,344.23 | $4,677.35 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $794.33 / $794.33 / $794.33
| Facility | 53 | $794.33 | $794.33 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $467.74 / $1,445.44
| Professional | | $169.82 | $467.74 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $3,630.78 / $8,511.38
| Facility | | $1,584.89 | $3,630.78 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $575.44 / $1,318.26
| Professional | | $204.17 | $575.44 | $1,318.26 |