- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $134.90 / $1,995.26 / $7,943.28
| Facility | | $134.90 | $1,995.26 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $316.23 / $933.25
| Professional | | $147.91 | $316.23 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,466.84 / $7,413.10 / $14,454.40
| Facility | | $4,466.84 | $7,413.10 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $537.03 / $1,122.02
| Professional | | $257.04 | $537.03 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $1,348.96 / $3,235.94
| Facility | | $933.25 | $1,348.96 | $3,235.94 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $51.29 / $51.29 / $51.29
| Facility | 53 | $51.29 | $51.29 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $676.08 / $1,445.44
| Professional | | $323.59 | $676.08 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,288.25 / $2,511.89
| Facility | | $1,047.13 | $1,288.25 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $575.44 / $1,258.93
| Professional | | $323.59 | $575.44 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $229.09 / $602.56 / $5,754.40
| Facility | | $229.09 | $602.56 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $707.95 / $1,819.70
| Professional | | $331.13 | $707.95 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $5,248.07 / $8,912.51
| Facility | | $2,884.03 | $5,248.07 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $467.74 / $1,096.48
| Professional | | $229.09 | $467.74 | $1,096.48 |