- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.96 / $2,691.53 / $7,585.78
| Facility | | $870.96 | $2,691.53 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $346.74 / $676.08
| Professional | | $269.15 | $346.74 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $1,445.44 / $1,995.26
| Facility | | $616.60 | $1,445.44 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $457.09 / $724.44
| Professional | | $323.59 | $457.09 | $724.44 |
- 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
- $295.12 / $416.87 / $660.69
| Professional | | $295.12 | $416.87 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $54.95 / $3,890.45 / $3,890.45
| Facility | | $54.95 | $3,890.45 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $1,380.38 / $1,380.38 / $1,380.38
| Facility | 54 | $1,380.38 | $1,380.38 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,454.71 / $2,951.21 / $2,951.21
| Professional | | $2,454.71 | $2,951.21 | $2,951.21 |
- 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
- $263.03 / $354.81 / $602.56
| Professional | | $263.03 | $354.81 | $602.56 |