- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $354.81 / $954.99 / $6,918.31
| Facility | | $354.81 | $954.99 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $524.81 / $524.81
| Facility | | $524.81 | $524.81 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $831.76 / $1,202.26
| Professional | | $831.76 | $831.76 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $645.65 / $1,000.00
| Facility | | $467.74 | $645.65 | $1,000.00 |
- 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 / $28,840.32
| Facility | | $4,786.30 | $4,786.30 | $28,840.32 |
- 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 |