- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.50 / $10,506.16 / $21,899.37
| Facility | | $4,570.50 | $10,506.16 | $21,899.37 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $433.39 / $433.39 / $433.39
| Facility | 54 | $433.39 | $433.39 | $433.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $577.85 / $1,084.97 / $4,997.58
| Professional | | $577.85 | $1,084.97 | $4,997.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,889.38 / $7,684.16 / $14,983.55
| Facility | | $5,889.38 | $7,684.16 | $14,983.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $559.97 / $954.49 / $1,272.65
| Professional | | $559.97 | $954.49 | $1,272.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,141.50 / $3,141.50 / $3,141.50
| Facility | | $3,141.50 | $3,141.50 | $3,141.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,215.55 / $1,450.14 / $2,146.89
| Professional | | $1,215.55 | $1,450.14 | $2,146.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $581.21 / $2,007.49 / $8,816.00
| Facility | | $581.21 | $2,007.49 | $8,816.00 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $7,881.75 / $7,881.75 / $7,881.75
| Facility | 54 | $7,881.75 | $7,881.75 | $7,881.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,348.10 / $1,752.52 / $2,632.15
| Professional | | $1,348.10 | $1,752.52 | $2,632.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,166.91 / $2,200.56 / $4,133.42
| Facility | | $1,166.91 | $2,200.56 | $4,133.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,215.55 / $1,890.42 / $2,321.07
| Professional | | $1,215.55 | $1,890.42 | $2,321.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,178.00 / $7,441.00 / $8,816.00
| Facility | | $6,178.00 | $7,441.00 | $8,816.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,389.15 / $1,995.18 / $2,204.58
| Professional | | $1,389.15 | $1,995.18 | $2,204.58 |