- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $388.40 / $1,285.44 / $6,214.00
| Facility | | $388.40 | $1,285.44 | $6,214.00 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $291.30 / $633.62 / $868.41
| Facility | 54 | $291.30 | $633.62 | $868.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $384.31 / $481.39 / $782.52
| Professional | | $384.31 | $481.39 | $782.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $848.97 / $848.97 / $848.97
| Professional | | $848.97 | $848.97 | $848.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,270.00 / $2,108.00 / $2,805.00
| Facility | | $1,270.00 | $2,108.00 | $2,805.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $439.21 / $608.95 / $952.54
| Professional | | $439.21 | $608.95 | $952.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.00 / $30.00 / $30.00
| Facility | | $30.00 | $30.00 | $30.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $462.62 / $638.00 / $986.37
| Professional | | $462.62 | $638.00 | $986.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,116.52 / $2,298.71 / $12,000.00
| Facility | | $2,116.52 | $2,298.71 | $12,000.00 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $1,455.99 / $1,609.10 / $1,609.10
| Facility | 54 | $1,455.99 | $1,609.10 | $1,609.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,262.96 / $3,741.04 / $4,364.78
| Professional | | $3,262.96 | $3,741.04 | $4,364.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $719.00 / $1,560.00 / $2,914.00
| Facility | | $719.00 | $1,560.00 | $2,914.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $429.16 / $544.89 / $1,043.27
| Professional | | $429.16 | $544.89 | $1,043.27 |