- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $3,388.44 / $7,079.46
| Facility | | $467.74 | $3,388.44 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.65 / $151.36 / $389.05
| Professional | | $109.65 | $151.36 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- 54
- Low / Median / High Price
- $114.82 / $245.47 / $354.81
| Professional | 54 | $114.82 | $245.47 | $354.81 |
- 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
- $112.20 / $239.88 / $338.84
| Professional | | $112.20 | $239.88 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.12 / $50.12 / $218.78
| Facility | | $50.12 | $50.12 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.25 / $213.80 / $354.81
| Professional | | $141.25 | $213.80 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.90 / $169.82 / $269.15
| Professional | | $134.90 | $169.82 | $269.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $467.74 / $467.74
| Facility | | $467.74 | $467.74 | $467.74 |
- 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
- $104.71 / $181.97 / $331.13
| Professional | | $104.71 | $181.97 | $331.13 |