- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.01 / $3,908.01 / $13,841.56
| Facility | | $398.01 | $3,908.01 | $13,841.56 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $269.27 / $269.27 / $298.51
| Facility | 54 | $269.27 | $269.27 | $298.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $359.03 / $398.01 / $2,035.18
| Professional | | $359.03 | $398.01 | $2,035.18 |
- 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
- $378.45 / $626.20 / $860.13
| Professional | | $378.45 | $626.20 | $860.13 |
- 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
- $622.00 / $902.20 / $1,211.20
| Professional | | $622.00 | $902.20 | $1,211.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $359.03 / $656.72 / $1,036.17
| Facility | | $359.03 | $656.72 | $1,036.17 |
- 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
- $514.74 / $858.32 / $2,924.56
| Professional | | $514.74 | $858.32 | $2,924.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $214.08 / $876.26 / $1,205.53
| Facility | | $214.08 | $876.26 | $1,205.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $710.66 / $876.26 / $1,205.53
| Professional | | $710.66 | $876.26 | $1,205.53 |
- 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
- $514.74 / $851.29 / $1,108.66
| Professional | | $514.74 | $851.29 | $1,108.66 |