- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $316.52 / $2,145.78 / $7,838.38
| Facility | | $316.52 | $2,145.78 | $7,838.38 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $220.48 / $220.48 / $237.39
| Facility | 54 | $220.48 | $220.48 | $237.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.62 / $293.97 / $543.26
| Professional | | $251.62 | $293.97 | $543.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $167.59 / $616.75 / $1,001.38
| Facility | | $167.59 | $616.75 | $1,001.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.10 / $374.91 / $523.33
| Professional | | $162.10 | $374.91 | $523.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $259.11 / $414.57 / $542.69
| Professional | | $259.11 | $414.57 | $542.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $53.86 / $448.90
| Professional | | $32.34 | $53.86 | $448.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $253.71 / $309.26 / $409.46
| Facility | | $253.71 | $309.26 | $409.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $297.97 / $438.10 / $719.14
| Professional | | $297.97 | $438.10 | $719.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $230.00 / $1,158.00 / $1,401.00
| Facility | | $230.00 | $1,158.00 | $1,401.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $315.73 / $429.74 / $617.19
| Professional | | $315.73 | $429.74 | $617.19 |