- 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
- $341.03 / $341.03 / $369.17
| Facility | 54 | $341.03 | $341.03 | $369.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $228.27 / $277.42 / $492.23
| Professional | | $228.27 | $277.42 | $492.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $381.39 / $381.39 / $381.39
| Professional | | $381.39 | $381.39 | $381.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $591.44 / $717.74 / $965.59
| Facility | | $591.44 | $717.74 | $965.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $303.80 / $434.00 / $512.12
| Professional | | $303.80 | $434.00 | $512.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $243.23 / $347.91 / $929.99
| Professional | | $243.23 | $347.91 | $929.99 |
- 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
- $238.19 / $290.19 / $493.32
| Professional | | $238.19 | $290.19 | $493.32 |