- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $316.23 / $3,090.30 / $10,471.29
| Facility | | $316.23 | $3,090.30 | $10,471.29 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $288.40 / $794.33 / $794.33
| Facility | 54 | $288.40 | $794.33 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $323.59 / $741.31
| Professional | | $257.04 | $323.59 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $3,715.35 / $9,549.93
| Facility | | $1,513.56 | $3,715.35 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $346.74 / $676.08
| Professional | | $229.09 | $346.74 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $123.03 / $489.78 / $2,344.23
| Facility | | $123.03 | $489.78 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $346.74 / $346.74 / $346.74
| Facility | 54 | $346.74 | $346.74 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $416.87 / $912.01
| Professional | | $275.42 | $416.87 | $912.01 |
- 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
- $234.42 / $331.13 / $630.96
| Professional | | $234.42 | $331.13 | $630.96 |