- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $2,691.53 / $7,585.78
| Facility | | $794.33 | $2,691.53 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $354.81 / $645.65
| Professional | | $251.19 | $354.81 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- 54
- Low / Median / High Price
- $295.12 / $512.86 / $794.33
| Professional | 54 | $295.12 | $512.86 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $1,445.44 / $1,995.26
| Facility | | $616.60 | $1,445.44 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $426.58 / $676.08
| Professional | | $295.12 | $426.58 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.20 / $30.20 / $30.20
| Facility | | $30.20 | $30.20 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $380.19 / $602.56
| Professional | | $269.15 | $380.19 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $54.95 / $3,467.37 / $3,467.37
| Facility | | $54.95 | $3,467.37 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $1,288.25 / $1,288.25 / $1,288.25
| Facility | 54 | $1,288.25 | $1,288.25 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,290.87 / $2,691.53 / $2,691.53
| Professional | | $2,290.87 | $2,691.53 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.12 / $812.83 / $2,511.89
| Facility | | $295.12 | $812.83 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $309.03 / $549.54
| Professional | | $234.42 | $309.03 | $549.54 |