- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $162.18 / $2,511.89 / $6,165.95
| Facility | | $162.18 | $2,511.89 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $354.81 / $870.96
| Professional | | $169.82 | $354.81 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $2,187.76 / $4,265.80
| Facility | | $1,071.52 | $2,187.76 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $630.96 / $1,288.25
| Professional | | $316.23 | $630.96 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $1,445.44 / $3,388.44
| Facility | | $891.25 | $1,445.44 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $354.81 / $354.81 / $354.81
| Facility | 22 | $354.81 | $354.81 | $354.81 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $239.88 / $239.88 / $239.88
| Facility | 52 | $239.88 | $239.88 | $239.88 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $58.88 / $58.88 / $58.88
| Facility | 53 | $58.88 | $58.88 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $707.95 / $1,584.89
| Professional | | $323.59 | $707.95 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,380.38 / $2,691.53
| Facility | | $1,096.48 | $1,380.38 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $676.08 / $1,318.26
| Professional | | $371.54 | $676.08 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $204.17 / $524.81 / $2,630.27
| Facility | | $204.17 | $524.81 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $707.95 / $2,818.38
| Professional | | $338.84 | $707.95 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $2,691.53 / $6,456.54
| Facility | | $1,445.44 | $2,691.53 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.53 / $457.09 / $1,122.02
| Professional | | $199.53 | $457.09 | $1,122.02 |