- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.11 / $2,884.03 / $5,128.61
| Facility | | $1,479.11 | $2,884.03 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $891.25 / $3,467.37
| Professional | | $389.05 | $891.25 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $7,413.10 / $28,840.32
| Facility | | $977.24 | $7,413.10 | $28,840.32 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $5,754.40 / $5,754.40 / $5,754.40
| Facility | 53 | $5,754.40 | $5,754.40 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $1,737.80 / $7,079.46
| Professional | | $446.68 | $1,737.80 | $7,079.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $478.63 / $478.63 / $1,122.02
| Facility | | $478.63 | $478.63 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.08 / $2,754.23 / $5,128.61
| Professional | | $676.08 | $2,754.23 | $5,128.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $1,995.26 / $1,995.26
| Facility | | $1,995.26 | $1,995.26 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $1,047.13 / $5,248.07
| Professional | | $501.19 | $1,047.13 | $5,248.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.19 / $812.83 / $7,079.46
| Facility | | $380.19 | $812.83 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,630.27 / $3,388.44 / $4,365.16
| Professional | | $2,630.27 | $3,388.44 | $4,365.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $6,918.31 / $14,791.08
| Facility | | $2,570.40 | $6,918.31 | $14,791.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $1,949.84 / $6,165.95
| Professional | | $457.09 | $1,949.84 | $6,165.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $3,090.30 / $7,943.28
| Facility | | $1,949.84 | $3,090.30 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $7,413.10 / $28,840.32
| Facility | | $977.24 | $7,413.10 | $28,840.32 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $5,754.40 / $5,754.40 / $5,754.40
| Facility | 53 | $5,754.40 | $5,754.40 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $1,737.80 / $7,079.46
| Professional | | $446.68 | $1,737.80 | $7,079.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $7,244.36 / $15,488.17
| Facility | | $2,570.40 | $7,244.36 | $15,488.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $1,479.11 / $5,754.40
| Professional | | $467.74 | $1,479.11 | $5,754.40 |