- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $3,548.13 / $8,511.38
| Facility | | $933.25 | $3,548.13 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $467.74 / $1,584.89
| Professional | | $154.88 | $467.74 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.89 / $281.84 / $891.25
| Professional | | $125.89 | $281.84 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.83 / $3,162.28 / $6,165.95
| Facility | | $2,398.83 | $3,162.28 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $398.11 / $954.99
| Professional | | $186.21 | $398.11 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $501.19 / $1,479.11
| Professional | | $181.97 | $501.19 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $257.04 / $1,258.93 / $3,801.89
| Facility | | $257.04 | $1,258.93 | $3,801.89 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $144.54 / $144.54 / $144.54
| Facility | 53 | $144.54 | $144.54 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $1,230.27 / $1,862.09
| Professional | | $724.44 | $1,230.27 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $1,071.52 / $1,584.89
| Professional | | $398.11 | $1,071.52 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $354.81 / $1,071.52
| Professional | | $354.81 | $354.81 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.02 / $794.33 / $1,380.38
| Professional | | $3.02 | $794.33 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $3,162.28 / $8,128.31
| Facility | | $2,041.74 | $3,162.28 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $724.44 / $1,318.26
| Professional | | $223.87 | $724.44 | $1,318.26 |