- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $186.05 / $198.32 / $2,000.00
| Facility | | $186.05 | $198.32 | $2,000.00 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $139.54 / $139.54 / $148.74
| Facility | 54 | $139.54 | $139.54 | $148.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $159.16 / $186.05 / $340.72
| Professional | | $159.16 | $186.05 | $340.72 |
- Facility/Professional
- Professional
- Modifier
- 54
- Low / Median / High Price
- $122.99 / $148.02 / $158.61
| Professional | 54 | $122.99 | $148.02 | $158.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $397.80 / $457.92 / $536.35
| Professional | | $397.80 | $457.92 | $536.35 |
- Facility/Professional
- Professional
- Modifier
- 54
- Low / Median / High Price
- $278.45 / $319.13 / $368.46
| Professional | 54 | $278.45 | $319.13 | $368.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $249.64 / $498.74 / $664.33
| Professional | | $249.64 | $498.74 | $664.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $186.05 / $260.39 / $367.00
| Facility | | $186.05 | $260.39 | $367.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.27 / $388.11 / $1,461.60
| Professional | | $204.27 | $388.11 | $1,461.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.27 / $361.56 / $449.39
| Professional | | $204.27 | $361.56 | $449.39 |