- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $88.23 / $270.42 / $298.88
| Facility | | $88.23 | $270.42 | $298.88 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $202.82 / $224.16 / $224.16
| Facility | 54 | $202.82 | $224.16 | $224.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $222.40 / $296.97 / $508.09
| Professional | | $222.40 | $296.97 | $508.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $306.48 / $778.05 / $2,440.53
| Facility | | $306.48 | $778.05 | $2,440.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $504.04 / $796.13 / $1,065.17
| Professional | | $504.04 | $796.13 | $1,065.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $739.13 / $1,048.71 / $2,522.82
| Facility | | $739.13 | $1,048.71 | $2,522.82 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $322.54 / $322.54 / $322.54
| Facility | 54 | $322.54 | $322.54 | $322.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $519.79 / $868.00 / $1,299.29
| Professional | | $519.79 | $868.00 | $1,299.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $671.93 / $958.78 / $1,986.48
| Facility | | $671.93 | $958.78 | $1,986.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $503.53 / $750.23 / $1,166.29
| Professional | | $503.53 | $750.23 | $1,166.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $259.86 / $480.74 / $793.62
| Facility | | $259.86 | $480.74 | $793.62 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $885.90 / $885.90 / $885.90
| Facility | 54 | $885.90 | $885.90 | $885.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $300.35 / $578.69 / $2,018.88
| Professional | | $300.35 | $578.69 | $2,018.88 |
- 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
- $300.35 / $543.88 / $1,064.33
| Professional | | $300.35 | $543.88 | $1,064.33 |