- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $502.52 / $927.00 / $2,250.00
| Facility | | $502.52 | $927.00 | $2,250.00 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $376.89 / $376.89 / $397.04
| Facility | 54 | $376.89 | $376.89 | $397.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.58 / $296.24 / $529.39
| Professional | | $251.58 | $296.24 | $529.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $347.32 / $347.32 / $347.32
| Professional | | $347.32 | $347.32 | $347.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $592.89 / $717.74 / $965.59
| Facility | | $592.89 | $717.74 | $965.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $387.43 / $556.00 / $656.08
| Professional | | $387.43 | $556.00 | $656.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.41 / $376.00 / $1,023.07
| Professional | | $269.41 | $376.00 | $1,023.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $241.00 / $850.00 / $1,349.00
| Facility | | $241.00 | $850.00 | $1,349.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $255.79 / $306.95 / $529.48
| Professional | | $255.79 | $306.95 | $529.48 |