- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $239.88 / $436.52 / $794.33
| Facility | | $239.88 | $436.52 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $3,090.30 / $5,754.40
| Facility | | $1,584.89 | $3,090.30 | $5,754.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,202.26 / $1,905.46
| Facility | | $1,023.29 | $1,202.26 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $338.84 / $524.81 / $3,162.28
| Facility | | $338.84 | $524.81 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $338.84 / $549.54 / $1,513.56
| Facility | | $338.84 | $549.54 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $1,122.02 / $1,548.82
| Professional | | $724.44 | $1,122.02 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $263.03 / $912.01 / $2,137.96
| Facility | | $263.03 | $912.01 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $630.96 / $630.96 / $1,513.56
| Facility | 54 | $630.96 | $630.96 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $1,548.82 / $1,949.84
| Facility | | $977.24 | $1,548.82 | $1,949.84 |