- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $281.75 / $307.74 / $2,000.00
| Facility | | $281.75 | $307.74 | $2,000.00 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $211.31 / $211.31 / $230.81
| Facility | 54 | $211.31 | $211.31 | $230.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $250.28 / $287.81 / $373.43
| Professional | | $250.28 | $287.81 | $373.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $593.74 / $683.48 / $804.08
| Professional | | $593.74 | $683.48 | $804.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.29 / $741.79 / $988.06
| Professional | | $371.29 | $741.79 | $988.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $281.75 / $365.11 / $555.71
| Facility | | $281.75 | $365.11 | $555.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $317.58 / $571.70 / $2,186.08
| Professional | | $317.58 | $571.70 | $2,186.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $317.58 / $548.03 / $698.70
| Professional | | $317.58 | $548.03 | $698.70 |