- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $361.46 / $3,908.01 / $13,841.56
| Facility | | $361.46 | $3,908.01 | $13,841.56 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $268.08 / $268.08 / $271.10
| Facility | 54 | $268.08 | $268.08 | $271.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $357.44 / $361.46 / $2,032.14
| Professional | | $357.44 | $361.46 | $2,032.14 |
- 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
- $350.70 / $591.79 / $797.05
| Professional | | $350.70 | $591.79 | $797.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $193.40 / $193.40 / $193.40
| Facility | | $193.40 | $193.40 | $193.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $576.00 / $872.75 / $1,145.42
| Professional | | $576.00 | $872.75 | $1,145.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $357.44 / $614.48 / $1,002.68
| Facility | | $357.44 | $614.48 | $1,002.68 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $1,275.83 / $1,275.83 / $1,275.83
| Facility | 54 | $1,275.83 | $1,275.83 | $1,275.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $470.26 / $782.29 / $2,911.84
| Professional | | $470.26 | $782.29 | $2,911.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $214.08 / $873.35 / $1,145.42
| Facility | | $214.08 | $873.35 | $1,145.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $648.54 / $875.76 / $1,145.42
| Professional | | $648.54 | $875.76 | $1,145.42 |
- 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
- $470.26 / $705.39 / $954.27
| Professional | | $470.26 | $705.39 | $954.27 |