- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $452.00 / $2,011.00 / $7,602.00
| Facility | | $452.00 | $2,011.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $204.08 / $443.91 / $608.41
| Facility | 54 | $204.08 | $443.91 | $608.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $266.35 / $314.31 / $524.54
| Professional | | $266.35 | $314.31 | $524.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $447.42 / $524.20 / $524.20
| Professional | | $447.42 | $524.20 | $524.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $756.00 / $1,487.00 / $2,244.00
| Facility | | $756.00 | $1,487.00 | $2,244.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.14 / $406.48 / $648.92
| Professional | | $295.14 | $406.48 | $648.92 |
- 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
- $315.88 / $419.42 / $647.01
| Professional | | $315.88 | $419.42 | $647.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,482.40 / $1,642.41 / $12,000.00
| Facility | | $1,482.40 | $1,642.41 | $12,000.00 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $1,021.52 / $1,149.69 / $1,149.69
| Facility | 54 | $1,021.52 | $1,149.69 | $1,149.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,295.52 / $2,416.23 / $2,808.38
| Professional | | $2,295.52 | $2,416.23 | $2,808.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $294.00 / $808.00 / $2,577.00
| Facility | | $294.00 | $808.00 | $2,577.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $279.45 / $381.46 / $707.59
| Professional | | $279.45 | $381.46 | $707.59 |