- 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
- $345.37 / $345.37 / $375.03
| Facility | 54 | $345.37 | $345.37 | $375.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $236.61 / $285.69 / $500.04
| Professional | | $236.61 | $285.69 | $500.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $299.45 / $299.45 / $299.45
| Professional | | $299.45 | $299.45 | $299.45 |
- 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
- $280.32 / $387.00 / $453.12
| Professional | | $280.32 | $387.00 | $453.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.54 / $366.57 / $956.37
| Professional | | $245.54 | $366.57 | $956.37 |
- 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
- $243.88 / $297.62 / $505.95
| Professional | | $243.88 | $297.62 | $505.95 |