- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $101.16 / $198.70 / $458.28
| Facility | | $101.16 | $198.70 | $458.28 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $75.87 / $75.87 / $91.30
| Facility | 54 | $75.87 | $75.87 | $91.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.31 / $103.78 / $210.28
| Professional | | $85.31 | $103.78 | $210.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.04 / $252.49 / $311.58
| Professional | | $213.04 | $252.49 | $311.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $192.18 / $270.05 / $401.91
| Professional | | $192.18 | $270.05 | $401.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $101.16 / $155.26 / $365.19
| Facility | | $101.16 | $155.26 | $365.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $124.15 / $234.80 / $950.56
| Professional | | $124.15 | $234.80 | $950.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,978.00 / $1,978.00 / $1,978.00
| Facility | | $1,978.00 | $1,978.00 | $1,978.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $122.54 / $204.85 / $297.32
| Professional | | $122.54 | $204.85 | $297.32 |