- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $407.38 / $2,398.83 / $8,317.64
| Facility | | $407.38 | $2,398.83 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $380.19 / $812.83
| Professional | | $275.42 | $380.19 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $3,630.78 / $8,709.64
| Facility | | $1,445.44 | $3,630.78 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $407.38 / $741.31
| Professional | | $269.15 | $407.38 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $575.44 / $2,344.23
| Facility | | $302.00 | $575.44 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $346.74 / $346.74 / $346.74
| Facility | 54 | $346.74 | $346.74 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $457.09 / $933.25
| Professional | | $295.12 | $457.09 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $204.17 / $1,071.52 / $3,388.44
| Facility | | $204.17 | $1,071.52 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $371.54 / $660.69
| Professional | | $251.19 | $371.54 | $660.69 |