- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $3,090.30 / $6,309.57
| Facility | | $1,445.44 | $3,090.30 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $537.03 / $1,445.44
| Professional | | $426.58 | $537.03 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $1,047.13 / $1,548.82
| Facility | | $323.59 | $1,047.13 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $724.44 / $1,348.96
| Professional | | $588.84 | $724.44 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $602.56 / $1,000.00
| Professional | | $436.52 | $602.56 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $630.96 / $1,905.46
| Facility | | $467.74 | $630.96 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $1,584.89 / $1,584.89 / $1,584.89
| Facility | 54 | $1,584.89 | $1,584.89 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $676.08 / $3,890.45
| Professional | | $446.68 | $676.08 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $204.17 / $1,202.26 / $2,187.76
| Facility | | $204.17 | $1,202.26 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $512.86 / $891.25
| Professional | | $416.87 | $512.86 | $891.25 |