- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $3,801.89 / $12,589.25
| Facility | | $549.54 | $3,801.89 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $398.11 / $1,258.93
| Professional | | $229.09 | $398.11 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $295.12 / $295.12
| Professional | | $295.12 | $295.12 | $295.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,388.44 / $4,365.16 / $8,511.38
| Facility | | $3,388.44 | $4,365.16 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $426.58 / $575.44
| Professional | | $245.47 | $426.58 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $204.17 / $204.17 / $204.17
| Facility | | $204.17 | $204.17 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $602.56 / $812.83
| Professional | | $295.12 | $602.56 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $275.42 / $436.52 / $1,230.27
| Facility | | $275.42 | $436.52 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $870.96 / $870.96 / $870.96
| Facility | 54 | $870.96 | $870.96 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $537.03 / $2,238.72
| Professional | | $316.23 | $537.03 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $645.65 / $812.83
| Professional | | $575.44 | $645.65 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $204.17 / $204.17 / $204.17
| Facility | | $204.17 | $204.17 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $691.83 / $912.01
| Professional | | $602.56 | $691.83 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $309.03 / $1,230.27 / $4,466.84
| Facility | | $309.03 | $1,230.27 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $446.68 / $691.83
| Professional | | $295.12 | $446.68 | $691.83 |