- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.74 / $2,570.40 / $6,606.93
| Facility | | $346.74 | $2,570.40 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $323.59 / $630.96
| Professional | | $275.42 | $323.59 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $1,737.80 / $2,818.38
| Facility | | $1,122.02 | $1,737.80 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $380.19 / $426.58
| Professional | | $281.84 | $380.19 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $208.93 / $208.93 / $208.93
| Facility | | $208.93 | $208.93 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $389.05 / $512.86
| Professional | | $288.40 | $389.05 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.12 / $416.87 / $1,659.59
| Facility | | $295.12 | $416.87 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $1,000.00 / $1,000.00 / $1,000.00
| Facility | 54 | $1,000.00 | $1,000.00 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $371.54 / $2,511.89
| Professional | | $269.15 | $371.54 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $138.04 / $616.60 / $1,659.59
| Facility | | $138.04 | $616.60 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $302.00 / $416.87
| Professional | | $234.42 | $302.00 | $416.87 |