- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $311.33 / $330.45 / $2,000.00
| Facility | | $311.33 | $330.45 | $2,000.00 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $233.50 / $233.50 / $247.84
| Facility | 54 | $233.50 | $233.50 | $247.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $267.30 / $301.27 / $410.07
| Professional | | $267.30 | $301.27 | $410.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.15 / $759.93 / $881.72
| Professional | | $660.15 | $759.93 | $881.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $392.68 / $825.33 / $1,099.34
| Professional | | $392.68 | $825.33 | $1,099.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $311.33 / $413.24 / $602.32
| Facility | | $311.33 | $413.24 | $602.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $341.05 / $608.28 / $2,426.88
| Professional | | $341.05 | $608.28 | $2,426.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $341.05 / $606.21 / $750.31
| Professional | | $341.05 | $606.21 | $750.31 |