- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $298.63 / $3,908.01 / $13,841.56
| Facility | | $298.63 | $3,908.01 | $13,841.56 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $215.15 / $215.15 / $223.97
| Facility | 54 | $215.15 | $215.15 | $223.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.51 / $298.63 / $1,517.00
| Professional | | $275.51 | $298.63 | $1,517.00 |
- 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
- $289.16 / $487.82 / $657.19
| Professional | | $289.16 | $487.82 | $657.19 |
- 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
- $424.00 / $701.60 / $940.76
| Professional | | $424.00 | $701.60 | $940.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $286.87 / $502.55 / $742.40
| Facility | | $286.87 | $502.55 | $742.40 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $1,021.52 / $1,021.52 / $1,021.52
| Facility | 54 | $1,021.52 | $1,021.52 | $1,021.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $384.85 / $639.41 / $2,332.71
| Professional | | $384.85 | $639.41 | $2,332.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $214.08 / $690.33 / $950.56
| Facility | | $214.08 | $690.33 | $950.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $503.00 / $701.60 / $935.23
| Professional | | $503.00 | $701.60 | $935.23 |
- 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
- $384.85 / $626.37 / $828.91
| Professional | | $384.85 | $626.37 | $828.91 |