- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,506.15 / $5,463.36 / $13,841.56
| Facility | | $1,506.15 | $5,463.36 | $13,841.56 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $323.56 / $323.56 / $323.56
| Facility | 54 | $323.56 | $323.56 | $323.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $431.41 / $431.41 / $2,444.67
| Professional | | $431.41 | $431.41 | $2,444.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,350.61 / $4,406.97 / $8,524.51
| Facility | | $3,350.61 | $4,406.97 | $8,524.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $418.95 / $714.13 / $952.17
| Professional | | $418.95 | $714.13 | $952.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,257.44 / $1,257.44 / $1,257.44
| Facility | | $1,257.44 | $1,257.44 | $1,257.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $667.00 / $1,043.58 / $1,366.85
| Professional | | $667.00 | $1,043.58 | $1,366.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $431.41 / $754.97 / $2,369.15
| Facility | | $431.41 | $754.97 | $2,369.15 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $856.06 / $3,154.80 / $3,154.80
| Facility | 54 | $856.06 | $3,154.80 | $3,154.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $561.66 / $928.91 / $1,279.91
| Professional | | $561.66 | $928.91 | $1,279.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $646.00 / $1,110.00 / $1,597.11
| Facility | | $646.00 | $1,110.00 | $1,597.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $750.00 / $929.07 / $1,366.85
| Professional | | $750.00 | $929.07 | $1,366.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,031.00 / $1,775.00 / $4,406.00
| Facility | | $1,031.00 | $1,775.00 | $4,406.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $561.66 / $842.50 / $1,139.75
| Professional | | $561.66 | $842.50 | $1,139.75 |