- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $231.09 / $232.17 / $2,000.00
| Facility | | $231.09 | $232.17 | $2,000.00 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $173.32 / $173.32 / $174.13
| Facility | 54 | $173.32 | $173.32 | $174.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $196.21 / $220.85 / $250.15
| Professional | | $196.21 | $220.85 | $250.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $492.48 / $543.55 / $637.36
| Professional | | $492.48 | $543.55 | $637.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.60 / $597.95 / $809.87
| Professional | | $302.60 | $597.95 | $809.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $231.09 / $304.86 / $425.86
| Facility | | $231.09 | $304.86 | $425.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $240.72 / $425.92 / $1,818.64
| Professional | | $240.72 | $425.92 | $1,818.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $240.72 / $437.69 / $604.00
| Professional | | $240.72 | $437.69 | $604.00 |