- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $318.77 / $351.14 / $2,046.00
| Facility | | $318.77 | $351.14 | $2,046.00 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $239.08 / $263.36 / $263.36
| Facility | 54 | $239.08 | $263.36 | $263.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $277.37 / $336.47 / $540.53
| Professional | | $277.37 | $336.47 | $540.53 |
- 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
- $583.09 / $923.51 / $1,234.09
| Professional | | $583.09 | $923.51 | $1,234.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $866.24 / $1,229.07 / $2,956.70
| Facility | | $866.24 | $1,229.07 | $2,956.70 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $369.72 / $369.72 / $369.72
| Facility | 54 | $369.72 | $369.72 | $369.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $612.05 / $1,012.79 / $1,519.98
| Professional | | $612.05 | $1,012.79 | $1,519.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $787.49 / $1,123.67 / $2,328.11
| Facility | | $787.49 | $1,123.67 | $2,328.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $589.05 / $887.64 / $1,364.39
| Professional | | $589.05 | $887.64 | $1,364.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $314.74 / $563.44 / $925.07
| Facility | | $314.74 | $563.44 | $925.07 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $1,024.70 / $1,024.70 / $1,024.70
| Facility | 54 | $1,024.70 | $1,024.70 | $1,024.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $365.13 / $683.54 / $2,346.32
| Professional | | $365.13 | $683.54 | $2,346.32 |
- 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
- $365.13 / $630.69 / $1,260.64
| Professional | | $365.13 | $630.69 | $1,260.64 |