- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $254.51 / $278.33 / $2,042.00
| Facility | | $254.51 | $278.33 | $2,042.00 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $190.88 / $208.76 / $208.76
| Facility | 54 | $190.88 | $208.76 | $208.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.48 / $278.33 / $434.46
| Professional | | $234.48 | $278.33 | $434.46 |
- 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
- $469.12 / $738.23 / $978.37
| Professional | | $469.12 | $738.23 | $978.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $688.62 / $977.05 / $2,350.42
| Facility | | $688.62 | $977.05 | $2,350.42 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $296.41 / $296.41 / $296.41
| Facility | 54 | $296.41 | $296.41 | $296.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.44 / $814.53 / $1,213.00
| Professional | | $489.44 | $814.53 | $1,213.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $626.02 / $893.26 / $1,850.73
| Facility | | $626.02 | $893.26 | $1,850.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $469.55 / $707.55 / $1,093.26
| Professional | | $469.55 | $707.55 | $1,093.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $268.36 / $454.77 / $748.71
| Facility | | $268.36 | $454.77 | $748.71 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $824.44 / $824.44 / $824.44
| Facility | 54 | $824.44 | $824.44 | $824.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $286.08 / $538.97 / $1,874.80
| Professional | | $286.08 | $538.97 | $1,874.80 |
- 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
- $298.52 / $568.50 / $1,017.26
| Professional | | $298.52 | $568.50 | $1,017.26 |