- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $407.38 / $3,235.94 / $7,079.46
| Facility | | $407.38 | $3,235.94 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $269.15 / $660.69
| Professional | | $173.78 | $269.15 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- 54
- Low / Median / High Price
- $302.00 / $416.87 / $575.44
| Professional | 54 | $302.00 | $416.87 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $3,162.28 / $10,471.29
| Facility | | $2,137.96 | $3,162.28 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $371.54 / $512.86
| Professional | | $190.55 | $371.54 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.12 / $50.12 / $354.81
| Facility | | $50.12 | $50.12 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $338.84 / $562.34
| Professional | | $223.87 | $338.84 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $281.84 / $1,202.26
| Professional | | $245.47 | $281.84 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $3,467.37 / $6,760.83
| Facility | | $1,288.25 | $3,467.37 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $288.40 / $537.03
| Professional | | $165.96 | $288.40 | $537.03 |