- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $271.45 / $283.91 / $2,042.00
| Facility | | $271.45 | $283.91 | $2,042.00 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $203.60 / $212.93 / $212.93
| Facility | 54 | $203.60 | $212.93 | $212.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $231.18 / $273.52 / $438.50
| Professional | | $231.18 | $273.52 | $438.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $306.48 / $778.05 / $2,613.48
| Facility | | $306.48 | $778.05 | $2,613.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $488.79 / $773.73 / $998.31
| Professional | | $488.79 | $773.73 | $998.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $698.72 / $991.38 / $2,384.90
| Facility | | $698.72 | $991.38 | $2,384.90 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $315.25 / $315.25 / $315.25
| Facility | 54 | $315.25 | $315.25 | $315.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $508.37 / $842.74 / $1,238.58
| Professional | | $508.37 | $842.74 | $1,238.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $635.20 / $906.36 / $1,877.88
| Facility | | $635.20 | $906.36 | $1,877.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $476.34 / $733.06 / $1,137.28
| Professional | | $476.34 | $733.06 | $1,137.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $271.45 / $479.81 / $780.78
| Facility | | $271.45 | $479.81 | $780.78 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $874.23 / $874.23 / $874.23
| Facility | 54 | $874.23 | $874.23 | $874.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $292.70 / $556.62 / $1,995.84
| Professional | | $292.70 | $556.62 | $1,995.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $382.00 / $1,727.00 / $2,883.00
| Facility | | $382.00 | $1,727.00 | $2,883.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $292.70 / $501.19 / $1,015.61
| Professional | | $292.70 | $501.19 | $1,015.61 |