- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $239.88 / $512.86 / $3,162.28
| Facility | | $239.88 | $512.86 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $4,570.88 / $7,079.46
| Facility | | $2,344.23 | $4,570.88 | $7,079.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,445.44 / $2,290.87
| Facility | | $1,230.27 | $1,445.44 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $389.05 / $616.60 / $3,162.28
| Facility | | $389.05 | $616.60 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $389.05 / $630.96 / $1,737.80
| Facility | | $389.05 | $630.96 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.33 / $1,258.93 / $1,737.80
| Professional | | $794.33 | $1,258.93 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $3,235.94 / $4,786.30
| Facility | | $1,737.80 | $3,235.94 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $2,238.72 / $2,238.72 / $3,311.31
| Facility | 54 | $2,238.72 | $2,238.72 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,584.89 / $2,187.76
| Facility | | $1,023.29 | $1,584.89 | $2,187.76 |