- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $447.48 / $498.01 / $2,000.00
| Facility | | $447.48 | $498.01 | $2,000.00 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $335.61 / $335.61 / $373.51
| Facility | 54 | $335.61 | $335.61 | $373.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $413.35 / $457.39 / $519.58
| Professional | | $413.35 | $457.39 | $519.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $928.42 / $1,092.26 / $1,301.43
| Professional | | $928.42 | $1,092.26 | $1,301.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $629.41 / $1,142.64 / $1,634.42
| Professional | | $629.41 | $1,142.64 | $1,634.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $447.48 / $599.39 / $888.43
| Facility | | $447.48 | $599.39 | $888.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $517.52 / $926.48 / $3,425.20
| Professional | | $517.52 | $926.48 | $3,425.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $517.52 / $916.01 / $1,138.54
| Professional | | $517.52 | $916.01 | $1,138.54 |