- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $192.09 / $215.41 / $761.76
| Facility | | $192.09 | $215.41 | $761.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $152.50 / $180.37 / $204.44
| Professional | | $152.50 | $180.37 | $204.44 |
- Facility/Professional
- Professional
- Modifier
- 54
- Low / Median / High Price
- $123.21 / $144.07 / $153.33
| Professional | 54 | $123.21 | $144.07 | $153.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $141.44 / $141.44 / $141.44
| Facility | | $141.44 | $141.44 | $141.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $153.38 / $197.01 / $352.71
| Professional | | $153.38 | $197.01 | $352.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $482.00 / $617.69 / $968.76
| Facility | | $482.00 | $617.69 | $968.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $197.55 / $213.36 / $383.13
| Professional | | $197.55 | $213.36 | $383.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $143.00 / $143.00 / $143.00
| Facility | | $143.00 | $143.00 | $143.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $159.61 / $200.98 / $449.10
| Professional | | $159.61 | $200.98 | $449.10 |