- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $318.83 / $345.52 / $345.52
| Facility | | $318.83 | $345.52 | $345.52 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $239.13 / $259.14 / $259.14
| Facility | 54 | $239.13 | $259.14 | $259.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.12 / $345.52 / $534.70
| Professional | | $281.12 | $345.52 | $534.70 |
- 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
- $584.29 / $923.25 / $1,212.99
| Professional | | $584.29 | $923.25 | $1,212.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $846.88 / $1,201.59 / $2,890.62
| Facility | | $846.88 | $1,201.59 | $2,890.62 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $371.55 / $371.55 / $371.55
| Facility | 54 | $371.55 | $371.55 | $371.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $604.01 / $991.02 / $1,483.44
| Professional | | $604.01 | $991.02 | $1,483.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $769.89 / $1,098.55 / $2,276.08
| Facility | | $769.89 | $1,098.55 | $2,276.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $574.90 / $872.90 / $1,352.19
| Professional | | $574.90 | $872.90 | $1,352.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $337.68 / $563.00 / $937.94
| Facility | | $337.68 | $563.00 | $937.94 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $1,026.83 / $1,026.83 / $1,026.83
| Facility | 54 | $1,026.83 | $1,026.83 | $1,026.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $347.56 / $674.61 / $2,345.92
| Professional | | $347.56 | $674.61 | $2,345.92 |
- 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
- $347.36 / $641.80 / $1,302.52
| Professional | | $347.36 | $641.80 | $1,302.52 |