- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $243.01 / $262.85 / $2,000.00
| Facility | | $243.01 | $262.85 | $2,000.00 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $182.26 / $182.26 / $197.14
| Facility | 54 | $182.26 | $182.26 | $197.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.20 / $243.01 / $427.15
| Professional | | $208.20 | $243.01 | $427.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $517.47 / $596.62 / $701.90
| Professional | | $517.47 | $596.62 | $701.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $308.08 / $646.42 / $861.04
| Professional | | $308.08 | $646.42 | $861.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $243.01 / $319.52 / $480.06
| Facility | | $243.01 | $319.52 | $480.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $271.02 / $488.20 / $1,896.00
| Professional | | $271.02 | $488.20 | $1,896.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $465.40 / $465.40 / $465.40
| Facility | | $465.40 | $465.40 | $465.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $271.02 / $479.72 / $567.30
| Professional | | $271.02 | $479.72 | $567.30 |