- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.74 / $380.19 / $1,047.13
| Facility | | $346.74 | $380.19 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $371.54 / $741.31
| Professional | | $295.12 | $371.54 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $363.08 / $870.96 / $2,290.87
| Facility | | $363.08 | $870.96 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $831.76 / $1,318.26
| Professional | | $562.34 | $831.76 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $1,380.38 / $3,311.31
| Facility | | $977.24 | $1,380.38 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $407.38 / $407.38 / $407.38
| Facility | 54 | $407.38 | $407.38 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $1,096.48 / $1,659.59
| Professional | | $645.65 | $1,096.48 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,318.26 / $2,630.27
| Facility | | $1,071.52 | $1,318.26 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $954.99 / $1,513.56
| Professional | | $645.65 | $954.99 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.13 / $602.56 / $1,047.13
| Facility | | $331.13 | $602.56 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $724.44 / $2,570.40
| Professional | | $363.08 | $724.44 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $1,819.70 / $3,467.37
| Facility | | $602.56 | $1,819.70 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $630.96 / $1,230.27
| Professional | | $338.84 | $630.96 | $1,230.27 |