- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $2,511.89 / $7,585.78
| Facility | | $660.69 | $2,511.89 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $398.11 / $398.11
| Facility | | $398.11 | $398.11 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,148.15 / $1,584.89
| Professional | | $1,148.15 | $1,148.15 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $912.01 / $1,380.38
| Facility | | $660.69 | $912.01 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $204.17 / $812.83 / $1,949.84
| Facility | | $204.17 | $812.83 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,786.30 / $4,786.30 / $19,498.45
| Facility | | $4,786.30 | $4,786.30 | $19,498.45 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $3,311.31 / $3,311.31 / $3,311.31
| Facility | 54 | $3,311.31 | $3,311.31 | $3,311.31 |