- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.00 / $927.00 / $2,250.00
| Facility | | $575.00 | $927.00 | $2,250.00 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $464.17 / $464.17 / $469.87
| Facility | 54 | $464.17 | $464.17 | $469.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $321.06 / $352.47 / $626.49
| Professional | | $321.06 | $352.47 | $626.49 |
- 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
- $284.70 / $429.00 / $502.14
| Professional | | $284.70 | $429.00 | $502.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $332.82 / $444.60 / $1,294.58
| Professional | | $332.82 | $444.60 | $1,294.58 |
- 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
- $302.88 / $372.26 / $646.14
| Professional | | $302.88 | $372.26 | $646.14 |