- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $4,897.79 / $16,595.87
| Facility | | $1,819.70 | $4,897.79 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $691.83 / $1,230.27 / $2,398.83
| Facility | | $691.83 | $1,230.27 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $575.44 / $1,174.90
| Facility | | $371.54 | $575.44 | $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
- $1,148.15 / $1,148.15 / $1,584.89
| Professional | | $1,148.15 | $1,148.15 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $912.01 / $1,513.56
| Facility | | $660.69 | $912.01 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $354.81 / $1,230.27 / $4,677.35
| Facility | | $354.81 | $1,230.27 | $4,677.35 |