- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $270.37 / $304.87 / $2,042.00
| Facility | | $270.37 | $304.87 | $2,042.00 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $202.78 / $228.65 / $228.65
| Facility | 54 | $202.78 | $228.65 | $228.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $235.96 / $302.92 / $469.63
| Professional | | $235.96 | $302.92 | $469.63 |
- 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
- $498.07 / $788.29 / $1,071.04
| Professional | | $498.07 | $788.29 | $1,071.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $750.91 / $1,065.44 / $2,563.05
| Facility | | $750.91 | $1,065.44 | $2,563.05 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $315.83 / $315.83 / $315.83
| Facility | 54 | $315.83 | $315.83 | $315.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $517.13 / $863.78 / $1,309.64
| Professional | | $517.13 | $863.78 | $1,309.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $682.65 / $974.06 / $2,018.15
| Facility | | $682.65 | $974.06 | $2,018.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $511.46 / $762.04 / $1,184.66
| Professional | | $511.46 | $762.04 | $1,184.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $281.27 / $482.30 / $795.34
| Facility | | $281.27 | $482.30 | $795.34 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $875.28 / $875.28 / $875.28
| Facility | 54 | $875.28 | $875.28 | $875.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $303.11 / $590.34 / $1,995.52
| Professional | | $303.11 | $590.34 | $1,995.52 |
- 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
- $303.11 / $564.88 / $1,073.57
| Professional | | $303.11 | $564.88 | $1,073.57 |