- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $746.22 / $746.22 / $3,073.00
| Facility | | $746.22 | $746.22 | $3,073.00 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $559.66 / $559.66 / $559.66
| Facility | 54 | $559.66 | $559.66 | $559.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $982.95 / $1,261.10 / $2,000.00
| Facility | | $982.95 | $1,261.10 | $2,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,145.18 / $1,715.23 / $2,020.28
| Facility | | $1,145.18 | $1,715.23 | $2,020.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $935.41 / $1,279.33 / $1,489.81
| Professional | | $935.41 | $1,279.33 | $1,489.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,000.00 / $2,000.00 / $2,000.00
| Facility | | $2,000.00 | $2,000.00 | $2,000.00 |