- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $498.85 / $927.00 / $2,250.00
| Facility | | $498.85 | $927.00 | $2,250.00 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $374.14 / $374.14 / $417.87
| Facility | 54 | $374.14 | $374.14 | $417.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $249.90 / $309.18 / $557.16
| Professional | | $249.90 | $309.18 | $557.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $189.85 / $189.85 / $189.85
| Professional | | $189.85 | $189.85 | $189.85 |
- 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
- $234.85 / $335.50 / $434.60
| Professional | | $234.85 | $335.50 | $434.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $267.45 / $376.40 / $1,015.97
| Professional | | $267.45 | $376.40 | $1,015.97 |
- 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
- $268.51 / $326.72 / $537.02
| Professional | | $268.51 | $326.72 | $537.02 |