- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $3,630.78 / $7,413.10
| Facility | | $1,148.15 | $3,630.78 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $2,238.72 / $4,786.30
| Facility | | $794.33 | $2,238.72 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $1,148.15 / $1,174.90
| Facility | | $645.65 | $1,148.15 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $812.83 / $812.83 / $812.83
| Facility | 54 | $812.83 | $812.83 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $1,023.29 / $3,801.89
| Professional | | $758.58 | $1,023.29 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- 54
- Low / Median / High Price
- $954.99 / $954.99 / $954.99
| Professional | 54 | $954.99 | $954.99 | $954.99 |
- 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 |