- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $3,090.30 / $6,309.57
| Facility | | $1,230.27 | $3,090.30 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $407.38 / $1,023.29
| Professional | | $281.84 | $407.38 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $363.08 / $446.68
| Professional | | $190.55 | $363.08 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $85.11 / $275.42 / $407.38
| Facility | | $85.11 | $275.42 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $489.78 / $912.01
| Professional | | $398.11 | $489.78 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $371.54 / $645.65
| Professional | | $269.15 | $371.54 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $416.87 / $1,862.09
| Facility | | $302.00 | $416.87 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $1,071.52 / $1,071.52 / $1,071.52
| Facility | 54 | $1,071.52 | $1,071.52 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $416.87 / $2,570.40
| Professional | | $281.84 | $416.87 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $204.17 / $1,202.26 / $2,187.76
| Facility | | $204.17 | $1,202.26 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $323.59 / $562.34
| Professional | | $257.04 | $323.59 | $562.34 |