- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $272.06 / $306.57 / $2,042.00
| Facility | | $272.06 | $306.57 | $2,042.00 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $209.39 / $229.93 / $229.93
| Facility | 54 | $209.39 | $229.93 | $229.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $236.65 / $291.32 / $446.38
| Professional | | $236.65 | $291.32 | $446.38 |
- 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
- $512.54 / $810.60 / $1,078.08
| Professional | | $512.54 | $810.60 | $1,078.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $755.12 / $1,071.41 / $2,577.42
| Facility | | $755.12 | $1,071.41 | $2,577.42 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $325.16 / $325.16 / $325.16
| Facility | 54 | $325.16 | $325.16 | $325.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $531.94 / $885.27 / $1,327.06
| Professional | | $531.94 | $885.27 | $1,327.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $686.47 / $979.52 / $2,029.46
| Facility | | $686.47 | $979.52 | $2,029.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $514.29 / $780.88 / $1,191.22
| Professional | | $514.29 | $780.88 | $1,191.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $267.20 / $494.34 / $807.79
| Facility | | $267.20 | $494.34 | $807.79 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $900.74 / $900.74 / $900.74
| Facility | 54 | $900.74 | $900.74 | $900.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.81 / $597.07 / $2,056.64
| Professional | | $316.81 | $597.07 | $2,056.64 |
- 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
- $316.81 / $547.22 / $1,130.91
| Professional | | $316.81 | $547.22 | $1,130.91 |