- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $316.23 / $1,698.24 / $7,762.47
| Facility | | $316.23 | $1,698.24 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $407.38 / $741.31
| Professional | | $269.15 | $407.38 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- 54
- Low / Median / High Price
- $309.03 / $446.68 / $724.44
| Professional | 54 | $309.03 | $446.68 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $389.05 / $977.24
| Professional | | $288.40 | $389.05 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $371.54 / $851.14
| Professional | | $288.40 | $371.54 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $616.60 / $741.31
| Professional | | $371.54 | $616.60 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $213.80 / $549.54 / $1,548.82
| Facility | | $213.80 | $549.54 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $371.54 / $851.14
| Professional | | $213.80 | $371.54 | $851.14 |