- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $407.38 / $1,202.26 / $2,454.71
| Facility | | $407.38 | $1,202.26 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $831.76 / $3,467.37
| Professional | | $380.19 | $831.76 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $12,589.25 / $30,199.52
| Facility | | $2,454.71 | $12,589.25 | $30,199.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $2,630.27 / $7,079.46
| Professional | | $758.58 | $2,630.27 | $7,079.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,165.95 / $8,709.64 / $20,892.96
| Facility | | $6,165.95 | $8,709.64 | $20,892.96 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $141.25 / $141.25 / $141.25
| Facility | 53 | $141.25 | $141.25 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $2,818.38 / $9,549.93
| Professional | | $912.01 | $2,818.38 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,760.83 / $8,128.31 / $16,218.10
| Facility | | $6,760.83 | $8,128.31 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.25 / $2,818.38 / $8,511.38
| Professional | | $891.25 | $2,818.38 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $478.63 / $2,238.72 / $8,128.31
| Facility | | $478.63 | $2,238.72 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,659.59 / $3,235.94 / $10,964.78
| Professional | | $1,659.59 | $3,235.94 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $9,332.54 / $13,182.57
| Facility | | $4,570.88 | $9,332.54 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $1,659.59 / $6,025.60
| Professional | | $512.86 | $1,659.59 | $6,025.60 |