- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $298.99 / $327.80 / $2,042.00
| Facility | | $298.99 | $327.80 | $2,042.00 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $224.24 / $245.85 / $245.85
| Facility | 54 | $224.24 | $245.85 | $245.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.06 / $318.63 / $555.40
| Professional | | $263.06 | $318.63 | $555.40 |
- 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 / $865.61 / $1,149.64
| Professional | | $544.50 | $865.61 | $1,149.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $806.47 / $1,144.27 / $2,752.69
| Facility | | $806.47 | $1,144.27 | $2,752.69 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $346.20 / $346.20 / $346.20
| Facility | 54 | $346.20 | $346.20 | $346.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $569.63 / $943.20 / $1,411.98
| Professional | | $569.63 | $943.20 | $1,411.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $733.16 / $1,046.14 / $2,167.48
| Facility | | $733.16 | $1,046.14 | $2,167.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $547.14 / $824.48 / $1,267.31
| Professional | | $547.14 | $824.48 | $1,267.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.94 / $553.04 / $897.00
| Facility | | $295.94 | $553.04 | $897.00 |
- 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
- $344.85 / $670.33 / $2,202.23
| Professional | | $344.85 | $670.33 | $2,202.23 |
- 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
- $344.82 / $612.83 / $1,255.16
| Professional | | $344.82 | $612.83 | $1,255.16 |