- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $5,754.40 / $12,882.50
| Facility | | $1,202.26 | $5,754.40 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $776.25 / $1,698.24
| Professional | | $588.84 | $776.25 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- 55
- Low / Median / High Price
- $158.49 / $158.49 / $158.49
| Professional | 55 | $158.49 | $158.49 | $158.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,467.37 / $10,471.29 / $20,417.38
| Facility | | $3,467.37 | $10,471.29 | $20,417.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $776.25 / $1,621.81
| Professional | | $537.03 | $776.25 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $2,187.76 / $6,025.60
| Facility | | $512.86 | $2,187.76 | $6,025.60 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $1,348.96 / $1,348.96 / $1,348.96
| Facility | 22 | $1,348.96 | $1,348.96 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $223.87 / $223.87 / $223.87
| Facility | 53 | $223.87 | $223.87 | $223.87 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $794.33 / $794.33 / $794.33
| Facility | 54 | $794.33 | $794.33 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- 55
- Low / Median / High Price
- $169.82 / $169.82 / $169.82
| Facility | 55 | $169.82 | $169.82 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.60 / $1,023.29 / $2,290.87
| Professional | | $616.60 | $1,023.29 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $7,079.46 / $15,848.93
| Facility | | $2,238.72 | $7,079.46 | $15,848.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $812.83 / $1,479.11
| Professional | | $588.84 | $812.83 | $1,479.11 |