- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $316.23 / $2,290.87 / $5,011.87
| Facility | | $316.23 | $2,290.87 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $363.08 / $1,047.13
| Professional | | $162.18 | $363.08 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $363.08 / $4,897.79 / $19,498.45
| Facility | | $363.08 | $4,897.79 | $19,498.45 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $1,905.46 / $1,905.46 / $1,905.46
| Facility | 53 | $1,905.46 | $1,905.46 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $354.81 / $1,071.52
| Professional | | $162.18 | $354.81 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $173.78 / $173.78 / $407.38
| Facility | | $173.78 | $173.78 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $478.63 / $1,122.02
| Professional | | $245.47 | $478.63 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.98 / $389.05 / $977.24
| Professional | | $194.98 | $389.05 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $138.04 / $380.19 / $7,079.46
| Facility | | $138.04 | $380.19 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $338.84 / $575.44
| Professional | | $208.93 | $338.84 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $4,265.80 / $9,772.37
| Facility | | $1,995.26 | $4,265.80 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $371.54 / $851.14
| Professional | | $162.18 | $371.54 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $2,041.74 / $4,365.16
| Facility | | $1,071.52 | $2,041.74 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $309.03 / $346.74
| Professional | | $162.18 | $309.03 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $363.08 / $4,897.79 / $19,498.45
| Facility | | $363.08 | $4,897.79 | $19,498.45 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $1,905.46 / $1,905.46 / $1,905.46
| Facility | 53 | $1,905.46 | $1,905.46 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $346.74 / $1,047.13
| Professional | | $162.18 | $346.74 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $4,265.80 / $9,772.37
| Facility | | $1,862.09 | $4,265.80 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $346.74 / $870.96
| Professional | | $204.17 | $346.74 | $870.96 |