- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $1,995.26 / $7,762.47
| Facility | | $436.52 | $1,995.26 | $7,762.47 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $288.40 / $1,071.52 / $1,288.25
| Facility | 54 | $288.40 | $1,071.52 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $446.68 / $912.01
| Professional | | $354.81 | $446.68 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $3,630.78 / $8,709.64
| Facility | | $1,445.44 | $3,630.78 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $501.19 / $954.99
| Professional | | $363.08 | $501.19 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $251.19 / $1,318.26 / $3,235.94
| Facility | | $251.19 | $1,318.26 | $3,235.94 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $467.74 / $467.74 / $467.74
| Facility | 54 | $467.74 | $467.74 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $575.44 / $1,230.27
| Professional | | $389.05 | $575.44 | $1,230.27 |
- 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
- $331.13 / $478.63 / $891.25
| Professional | | $331.13 | $478.63 | $891.25 |