- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $485.00 / $927.00 / $2,250.00
| Facility | | $485.00 | $927.00 | $2,250.00 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $359.97 / $359.97 / $388.11
| Facility | 54 | $359.97 | $359.97 | $388.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $242.34 / $294.83 / $517.48
| Professional | | $242.34 | $294.83 | $517.48 |
- 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
- $336.70 / $481.00 / $561.28
| Professional | | $336.70 | $481.00 | $561.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.20 / $367.72 / $982.62
| Professional | | $257.20 | $367.72 | $982.62 |
- 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
- $250.37 / $305.20 / $518.86
| Professional | | $250.37 | $305.20 | $518.86 |