- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $297.25 / $323.22 / $323.22
| Facility | | $297.25 | $323.22 | $323.22 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $222.94 / $242.42 / $242.42
| Facility | 54 | $222.94 | $242.42 | $242.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $248.53 / $303.61 / $498.17
| Professional | | $248.53 | $303.61 | $498.17 |
- 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
- $544.50 / $860.78 / $1,134.39
| Professional | | $544.50 | $860.78 | $1,134.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $796.37 / $1,129.94 / $2,718.21
| Facility | | $796.37 | $1,129.94 | $2,718.21 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $345.03 / $345.03 / $345.03
| Facility | 54 | $345.03 | $345.03 | $345.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $566.52 / $943.14 / $1,411.98
| Professional | | $566.52 | $943.14 | $1,411.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $723.97 / $1,033.03 / $2,140.33
| Facility | | $723.97 | $1,033.03 | $2,140.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $542.61 / $814.49 / $1,265.88
| Professional | | $542.61 | $814.49 | $1,265.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $309.89 / $526.71 / $874.43
| Facility | | $309.89 | $526.71 | $874.43 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $956.89 / $956.89 / $956.89
| Facility | 54 | $956.89 | $956.89 | $956.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $332.39 / $634.33 / $2,186.40
| Professional | | $332.39 | $634.33 | $2,186.40 |
- 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
- $331.55 / $543.91 / $1,153.91
| Professional | | $331.55 | $543.91 | $1,153.91 |