- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $15,135.61 / $15,135.61
| Facility | | $467.74 | $15,135.61 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $630.96 / $912.01
| Professional | | $446.68 | $630.96 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $489.78 / $588.84
| Facility | | $489.78 | $489.78 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $524.81 / $524.81
| Professional | | $524.81 | $524.81 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $794.33 / $2,290.87
| Facility | | $794.33 | $794.33 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $549.54 / $549.54 / $549.54
| Facility | 54 | $549.54 | $549.54 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $645.65 / $3,090.30
| Professional | | $426.58 | $645.65 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,317.64 / $8,317.64 / $8,709.64
| Facility | | $8,317.64 | $8,317.64 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $645.65 / $645.65
| Professional | | $645.65 | $645.65 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $2,454.71 / $6,606.93
| Facility | | $2,454.71 | $2,454.71 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $562.34 / $954.99
| Professional | | $380.19 | $562.34 | $954.99 |