- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.74 / $2,344.23 / $8,317.64
| Facility | | $346.74 | $2,344.23 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $512.86 / $512.86 / $512.86
| Facility | 54 | $512.86 | $512.86 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $316.23 / $691.83
| Professional | | $239.88 | $316.23 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $4,570.88 / $10,000.00
| Facility | | $1,548.82 | $4,570.88 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $316.23 / $616.60
| Professional | | $208.93 | $316.23 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.12 / $707.95 / $2,238.72
| Facility | | $50.12 | $707.95 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $316.23 / $316.23 / $316.23
| Facility | 54 | $316.23 | $316.23 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $380.19 / $831.76
| Professional | | $251.19 | $380.19 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $204.17 / $1,071.52 / $3,467.37
| Facility | | $204.17 | $1,071.52 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $302.00 / $588.84
| Professional | | $213.80 | $302.00 | $588.84 |