- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $537.03 / $1,258.93
| Facility | | $489.78 | $537.03 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $537.03 / $977.24
| Professional | | $436.52 | $537.03 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.19 / $870.96 / $2,290.87
| Facility | | $380.19 | $870.96 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.33 / $1,202.26 / $1,862.09
| Professional | | $794.33 | $1,202.26 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.38 / $1,949.84 / $4,570.88
| Facility | | $1,380.38 | $1,949.84 | $4,570.88 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $575.44 / $575.44 / $575.44
| Facility | 54 | $575.44 | $575.44 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.25 / $1,513.56 / $2,290.87
| Professional | | $891.25 | $1,513.56 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.11 / $1,862.09 / $3,630.78
| Facility | | $1,479.11 | $1,862.09 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $954.99 / $1,318.26 / $2,089.30
| Professional | | $954.99 | $1,318.26 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $831.76 / $1,445.44
| Facility | | $501.19 | $831.76 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $1,023.29 / $3,630.78
| Professional | | $524.81 | $1,023.29 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $1,819.70 / $3,467.37
| Facility | | $602.56 | $1,819.70 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $912.01 / $1,778.28
| Professional | | $501.19 | $912.01 | $1,778.28 |