- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $2,454.71 / $4,365.16
| Facility | | $512.86 | $2,454.71 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.25 / $457.09 / $1,659.59
| Professional | | $141.25 | $457.09 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $3,235.94 / $7,413.10
| Facility | | $1,000.00 | $3,235.94 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $645.65 / $1,513.56
| Professional | | $275.42 | $645.65 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $1,862.09 / $4,466.84
| Facility | | $1,288.25 | $1,862.09 | $4,466.84 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $54.95 / $54.95 / $54.95
| Facility | 53 | $54.95 | $54.95 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $851.14 / $2,089.30
| Professional | | $371.54 | $851.14 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $1,778.28 / $3,548.13
| Facility | | $1,445.44 | $1,778.28 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $831.76 / $1,949.84
| Professional | | $346.74 | $831.76 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $2,089.30 / $3,630.78
| Facility | | $302.00 | $2,089.30 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $1,380.38 / $2,511.89
| Professional | | $776.25 | $1,380.38 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $4,168.69 / $6,760.83
| Facility | | $1,584.89 | $4,168.69 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $676.08 / $1,905.46
| Professional | | $251.19 | $676.08 | $1,905.46 |