- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $2,137.96 / $4,073.80
| Facility | | $562.34 | $2,137.96 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $309.03 / $602.56
| Professional | | $234.42 | $309.03 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $1,513.56 / $2,137.96
| Facility | | $724.44 | $1,513.56 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $407.38 / $630.96
| Professional | | $288.40 | $407.38 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.20 / $30.20 / $30.20
| Facility | | $30.20 | $30.20 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $371.54 / $588.84
| Professional | | $263.03 | $371.54 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $1,995.26 / $19,498.45
| Facility | | $1,995.26 | $1,995.26 | $19,498.45 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $1,202.26 / $1,202.26 / $1,202.26
| Facility | 54 | $1,202.26 | $1,202.26 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,238.72 / $2,630.27 / $2,630.27
| Professional | | $2,238.72 | $2,630.27 | $2,630.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.12 / $812.83 / $2,511.89
| Facility | | $295.12 | $812.83 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $309.03 / $537.03
| Professional | | $234.42 | $309.03 | $537.03 |