- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $7,943.28 / $14,454.40
| Facility | | $645.65 | $7,943.28 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $467.74 / $1,584.89
| Professional | | $269.15 | $467.74 | $1,584.89 |
- 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
- $281.84 / $489.78 / $660.69
| Professional | | $281.84 | $489.78 | $660.69 |
- 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
- $338.84 / $707.95 / $954.99
| Professional | | $338.84 | $707.95 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $309.03 / $512.86 / $1,230.27
| Facility | | $309.03 | $512.86 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $1,023.29 / $1,023.29 / $1,023.29
| Facility | 54 | $1,023.29 | $1,023.29 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $645.65 / $2,511.89
| Professional | | $363.08 | $645.65 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.08 / $724.44 / $954.99
| Professional | | $676.08 | $724.44 | $954.99 |
- 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
- $707.95 / $776.25 / $1,047.13
| Professional | | $707.95 | $776.25 | $1,047.13 |
- 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
- $346.74 / $537.03 / $794.33
| Professional | | $346.74 | $537.03 | $794.33 |