- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $102.33 / $1,000.00 / $3,890.45
| Facility | | $102.33 | $1,000.00 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,801.89 / $10,715.19 / $11,220.18
| Facility | | $3,801.89 | $10,715.19 | $11,220.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $85.11 / $107.15 / $141.25
| Facility | | $85.11 | $107.15 | $141.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $162.18 / $162.18
| Facility | | $34.67 | $162.18 | $162.18 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $112.20 / $112.20 / $112.20
| Facility | 54 | $112.20 | $112.20 | $112.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.12 / $602.56 / $3,162.28
| Facility | | $50.12 | $602.56 | $3,162.28 |