- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,218.00 / $3,576.15 / $7,119.04
| Facility | | $2,218.00 | $3,576.15 | $7,119.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $94.12 / $165.99 / $316.25
| Professional | | $94.12 | $165.99 | $316.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $132.21 / $234.03 / $597.22
| Facility | | $132.21 | $234.03 | $597.22 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $306.24 / $306.24 / $306.24
| Facility | 54 | $306.24 | $306.24 | $306.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $126.42 / $210.21 / $313.62
| Facility | | $126.42 | $210.21 | $313.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,204.00 / $1,640.00 / $2,126.00
| Facility | | $1,204.00 | $1,640.00 | $2,126.00 |