- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $245.47 / $1,995.26 / $7,762.47
| Facility | | $245.47 | $1,995.26 | $7,762.47 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $263.03 / $316.23 / $446.68
| Facility | 54 | $263.03 | $316.23 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $251.19 / $549.54
| Professional | | $173.78 | $251.19 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- 54
- Low / Median / High Price
- $190.55 / $309.03 / $575.44
| Professional | 54 | $190.55 | $309.03 | $575.44 |
- 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
- $147.91 / $223.87 / $457.09
| Professional | | $147.91 | $223.87 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.12 / $549.54 / $1,548.82
| Facility | | $50.12 | $549.54 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $229.09 / $229.09 / $229.09
| Facility | 54 | $229.09 | $229.09 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $275.42 / $602.56
| Professional | | $181.97 | $275.42 | $602.56 |
- 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
- $154.88 / $218.78 / $416.87
| Professional | | $154.88 | $218.78 | $416.87 |