- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $454.65 / $1,251.00 / $2,250.00
| Facility | | $454.65 | $1,251.00 | $2,250.00 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $340.99 / $340.99 / $357.72
| Facility | 54 | $340.99 | $340.99 | $357.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $225.61 / $269.68 / $477.38
| Professional | | $225.61 | $269.68 | $477.38 |
- Facility/Professional
- Professional
- Modifier
- 54
- Low / Median / High Price
- $169.21 / $200.24 / $357.72
| Professional | 54 | $169.21 | $200.24 | $357.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $591.44 / $717.74 / $965.59
| Facility | | $591.44 | $717.74 | $965.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $200.75 / $299.79 / $382.28
| Professional | | $200.75 | $299.79 | $382.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.00 / $330.66 / $919.61
| Professional | | $186.00 | $330.66 | $919.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $241.00 / $850.00 / $1,349.00
| Facility | | $241.00 | $850.00 | $1,349.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.93 / $279.97 / $472.48
| Professional | | $223.93 | $279.97 | $472.48 |