- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $4,365.16 / $8,128.31
| Facility | | $436.52 | $4,365.16 | $8,128.31 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $1,230.27 / $1,230.27 / $1,230.27
| Facility | 54 | $1,230.27 | $1,230.27 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $281.84 / $794.33
| Professional | | $213.80 | $281.84 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $3,162.28 / $11,748.98
| Facility | | $2,137.96 | $3,162.28 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $467.74 / $645.65
| Professional | | $218.78 | $467.74 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $354.81 / $354.81 / $549.54
| Facility | | $354.81 | $354.81 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $416.87 / $691.83
| Professional | | $269.15 | $416.87 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $363.08 / $562.34
| Professional | | $281.84 | $363.08 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $3,467.37 / $6,760.83
| Facility | | $1,288.25 | $3,467.37 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $363.08 / $660.69
| Professional | | $204.17 | $363.08 | $660.69 |