- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,346.00 / $4,634.00 / $14,100.00
| Facility | | $1,346.00 | $4,634.00 | $14,100.00 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $386.90 / $386.90 / $544.73
| Facility | 54 | $386.90 | $386.90 | $544.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $477.75 / $627.99 / $726.30
| Professional | | $477.75 | $627.99 | $726.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $431.65 / $431.65 / $539.55
| Professional | | $431.65 | $431.65 | $539.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,103.39 / $6,529.28 / $10,390.44
| Facility | | $4,103.39 | $6,529.28 | $10,390.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $449.05 / $635.25 / $872.29
| Professional | | $449.05 | $635.25 | $872.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,070.25 / $1,070.25 / $1,070.25
| Facility | | $1,070.25 | $1,070.25 | $1,070.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $437.37 / $621.88 / $914.00
| Professional | | $437.37 | $621.88 | $914.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.00 / $888.70 / $5,834.42
| Facility | | $537.00 | $888.70 | $5,834.42 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $1,513.22 / $1,513.22 / $1,513.22
| Facility | 54 | $1,513.22 | $1,513.22 | $1,513.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $543.66 / $665.98 / $3,567.28
| Professional | | $543.66 | $665.98 | $3,567.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $884.00 / $2,900.00 / $5,543.93
| Facility | | $884.00 | $2,900.00 | $5,543.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $543.66 / $659.18 / $883.44
| Professional | | $543.66 | $659.18 | $883.44 |