- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $218.78 / $1,122.02 / $6,456.54
| Facility | | $218.78 | $1,122.02 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $398.11 / $660.69 / $1,548.82
| Facility | 54 | $398.11 | $660.69 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $251.19 / $645.65
| Professional | | $154.88 | $251.19 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $3,630.78 / $8,709.64
| Facility | | $1,445.44 | $3,630.78 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $213.80 / $416.87
| Professional | | $147.91 | $213.80 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $218.78 / $316.23 / $602.56
| Professional | 50 | $218.78 | $316.23 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $147.91 / $389.05 / $1,584.89
| Facility | | $147.91 | $389.05 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $213.80 / $213.80 / $213.80
| Facility | 54 | $213.80 | $213.80 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $263.03 / $575.44
| Professional | | $173.78 | $263.03 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $1,122.02 / $3,467.37
| Facility | | $302.00 | $1,122.02 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $208.93 / $398.11
| Professional | | $147.91 | $208.93 | $398.11 |