- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $5,370.32 / $9,772.37
| Facility | | $489.78 | $5,370.32 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $912.01 / $3,162.28
| Professional | | $363.08 | $912.01 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $588.84 / $3,548.13
| Professional | | $338.84 | $588.84 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $11,220.18 / $24,547.09
| Facility | | $2,951.21 | $11,220.18 | $24,547.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $954.99 / $2,398.83
| Professional | | $389.05 | $954.99 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $707.95 / $2,344.23
| Facility | | $501.19 | $707.95 | $2,344.23 |
- 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
- $467.74 / $776.25 / $3,630.78
| Professional | | $467.74 | $776.25 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.69 / $660.69 / $5,370.32
| Professional | | $660.69 | $660.69 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $426.58 / $758.58 / $3,311.31
| Facility | | $426.58 | $758.58 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $33.11
| Professional | | $32.36 | $33.11 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,677.35 / $20,892.96 / $30,902.95
| Facility | | $4,677.35 | $20,892.96 | $30,902.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $1,174.90 / $2,398.83
| Professional | | $363.08 | $1,174.90 | $2,398.83 |