- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $2,884.03 / $7,079.46
| Facility | | $630.96 | $2,884.03 | $7,079.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.99 / $2,238.72 / $4,786.30
| Facility | | $954.99 | $2,238.72 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $851.14 / $1,148.15
| Facility | | $794.33 | $851.14 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $562.34 / $562.34 / $562.34
| Facility | 54 | $562.34 | $562.34 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $831.76 / $3,715.35
| Professional | | $575.44 | $831.76 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- 54
- Low / Median / High Price
- $660.69 / $660.69 / $741.31
| Professional | 54 | $660.69 | $660.69 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $177.83 / $1,479.11 / $2,511.89
| Facility | | $177.83 | $1,479.11 | $2,511.89 |