- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $190.55 / $204.17 / $7,762.47
| Facility | | $190.55 | $204.17 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.33 / $125.89 / $457.09
| Professional | | $102.33 | $125.89 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- 54
- Low / Median / High Price
- $309.03 / $309.03 / $316.23
| Professional | 54 | $309.03 | $309.03 | $316.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $281.84 / $616.60 / $1,000.00
| Facility | | $281.84 | $616.60 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $147.91 / $181.97
| Professional | | $100.00 | $147.91 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.72 / $162.18 / $239.88
| Professional | | $97.72 | $162.18 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $104.71
| Professional | | $32.36 | $33.11 | $104.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $114.82 / $144.54 / $234.42
| Facility | | $114.82 | $144.54 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.65 / $173.78 / $281.84
| Professional | | $109.65 | $173.78 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $229.09 / $1,096.48 / $1,412.54
| Facility | | $229.09 | $1,096.48 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.49 / $165.96 / $234.42
| Professional | | $117.49 | $165.96 | $234.42 |