- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.74 / $1,995.26 / $7,943.28
| Facility | | $346.74 | $1,995.26 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $50.12 / $794.33 / $1,000.00
| Facility | 54 | $50.12 | $794.33 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $389.05 / $812.83
| Professional | | $269.15 | $389.05 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $3,630.78 / $8,709.64
| Facility | | $1,445.44 | $3,630.78 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $363.08 / $707.95
| Professional | | $257.04 | $363.08 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.12 / $549.54 / $2,398.83
| Facility | | $295.12 | $549.54 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $346.74 / $346.74 / $346.74
| Facility | 54 | $346.74 | $346.74 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $426.58 / $912.01
| Professional | | $288.40 | $426.58 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $204.17 / $1,071.52 / $3,467.37
| Facility | | $204.17 | $1,071.52 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $346.74 / $660.69
| Professional | | $245.47 | $346.74 | $660.69 |