- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $199.53 / $1,995.26 / $7,762.47
| Facility | | $199.53 | $1,995.26 | $7,762.47 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $128.82 / $218.78 / $346.74
| Facility | 54 | $128.82 | $218.78 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $169.82 / $407.38
| Professional | | $131.83 | $169.82 | $407.38 |
- 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
- $102.33 / $169.82 / $346.74
| Professional | | $102.33 | $169.82 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $104.71 / $245.47 / $1,258.93
| Facility | | $104.71 | $245.47 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $173.78 / $173.78 / $173.78
| Facility | 54 | $173.78 | $173.78 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $218.78 / $478.63
| Professional | | $144.54 | $218.78 | $478.63 |
- 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
- $123.03 / $173.78 / $331.13
| Professional | | $123.03 | $173.78 | $331.13 |