- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $309.03 / $1,202.26 / $9,120.11
| Facility | | $309.03 | $1,202.26 | $9,120.11 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $223.87 / $501.19 / $1,819.70
| Facility | 54 | $223.87 | $501.19 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $380.19 / $758.58
| Professional | | $263.03 | $380.19 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- 54
- Low / Median / High Price
- $309.03 / $457.09 / $776.25
| Professional | 54 | $309.03 | $457.09 | $776.25 |
- 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
- $204.17 / $331.13 / $676.08
| Professional | | $204.17 | $331.13 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $125.89 / $501.19 / $2,344.23
| Facility | | $125.89 | $501.19 | $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
- $263.03 / $407.38 / $891.25
| Professional | | $263.03 | $407.38 | $891.25 |
- 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
- $223.87 / $323.59 / $616.60
| Professional | | $223.87 | $323.59 | $616.60 |