- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $452.00 / $2,011.00 / $7,602.00
| Facility | | $452.00 | $2,011.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $207.92 / $452.27 / $619.85
| Facility | 54 | $207.92 | $452.27 | $619.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $274.31 / $334.15 / $540.57
| Professional | | $274.31 | $334.15 | $540.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $513.99 / $513.99 / $513.99
| Professional | | $513.99 | $513.99 | $513.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $764.00 / $1,487.00 / $2,244.00
| Facility | | $764.00 | $1,487.00 | $2,244.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.92 / $426.41 / $669.72
| Professional | | $309.92 | $426.41 | $669.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.00 / $30.00 / $30.00
| Facility | | $30.00 | $30.00 | $30.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $330.15 / $440.57 / $679.39
| Professional | | $330.15 | $440.57 | $679.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,535.12 / $1,704.82 / $12,000.00
| Facility | | $1,535.12 | $1,704.82 | $12,000.00 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $1,053.30 / $1,193.36 / $1,193.36
| Facility | 54 | $1,053.30 | $1,193.36 | $1,193.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,364.32 / $2,708.08 / $3,151.50
| Professional | | $2,364.32 | $2,708.08 | $3,151.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $294.00 / $808.00 / $2,577.00
| Facility | | $294.00 | $808.00 | $2,577.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.18 / $381.94 / $716.58
| Professional | | $302.18 | $381.94 | $716.58 |