- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $703.73 / $1,451.00 / $5,091.00
| Facility | | $703.73 | $1,451.00 | $5,091.00 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $527.79 / $956.87 / $1,089.92
| Facility | 54 | $527.79 | $956.87 | $1,089.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,202.15 / $7,544.52 / $16,455.56
| Facility | | $2,202.15 | $7,544.52 | $16,455.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $463.00 / $1,631.14 / $1,820.98
| Facility | | $463.00 | $1,631.14 | $1,820.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $787.37 / $1,167.02 / $3,267.02
| Professional | | $787.37 | $1,167.02 | $3,267.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $165.00 / $891.00 / $3,685.00
| Facility | | $165.00 | $891.00 | $3,685.00 |