- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $107.15 / $3,801.89 / $9,772.37
| Facility | | $107.15 | $3,801.89 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $204.17 / $354.81 / $676.08
| Facility | | $204.17 | $354.81 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $125.89 / $162.18
| Facility | | $100.00 | $125.89 | $162.18 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $112.20 / $112.20 / $112.20
| Facility | 54 | $112.20 | $112.20 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $162.18 / $281.84
| Professional | | $162.18 | $162.18 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $95.50 / $138.04 / $251.19
| Facility | | $95.50 | $138.04 | $251.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $354.81 / $1,202.26 / $3,548.13
| Facility | | $354.81 | $1,202.26 | $3,548.13 |