- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $268.83 / $298.70 / $2,042.00
| Facility | | $268.83 | $298.70 | $2,042.00 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $201.62 / $224.03 / $224.03
| Facility | 54 | $201.62 | $224.03 | $224.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $221.28 / $275.27 / $416.48
| Professional | | $221.28 | $275.27 | $416.48 |
- 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
- $495.66 / $784.41 / $1,051.09
| Professional | | $495.66 | $784.41 | $1,051.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $737.44 / $1,046.33 / $2,517.08
| Facility | | $737.44 | $1,046.33 | $2,517.08 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $314.41 / $314.41 / $314.41
| Facility | 54 | $314.41 | $314.41 | $314.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.47 / $863.79 / $1,296.35
| Professional | | $512.47 | $863.79 | $1,296.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $670.40 / $956.59 / $1,981.95
| Facility | | $670.40 | $956.59 | $1,981.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $502.40 / $757.05 / $1,163.67
| Professional | | $502.40 | $757.05 | $1,163.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $277.12 / $478.61 / $790.83
| Facility | | $277.12 | $478.61 | $790.83 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $871.06 / $871.06 / $871.06
| Facility | 54 | $871.06 | $871.06 | $871.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $298.27 / $569.47 / $1,987.04
| Professional | | $298.27 | $569.47 | $1,987.04 |
- 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
- $307.20 / $564.77 / $1,089.79
| Professional | | $307.20 | $564.77 | $1,089.79 |