- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $169.82 / $2,290.87 / $8,128.31
| Facility | | $169.82 | $2,290.87 | $8,128.31 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $154.88 / $346.74 / $1,621.81
| Facility | 54 | $154.88 | $346.74 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.15 / $147.91 / $323.59
| Professional | | $107.15 | $147.91 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- 54
- Low / Median / High Price
- $114.82 / $194.98 / $316.23
| Professional | 54 | $114.82 | $194.98 | $316.23 |
- 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
- $83.18 / $141.25 / $288.40
| Professional | | $83.18 | $141.25 | $288.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.12 / $295.12 / $933.25
| Facility | | $50.12 | $295.12 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $144.54 / $144.54 / $144.54
| Facility | 54 | $144.54 | $144.54 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $169.82 / $354.81
| Professional | | $114.82 | $169.82 | $354.81 |
- 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
- $97.72 / $138.04 / $263.03
| Professional | | $97.72 | $138.04 | $263.03 |