- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,078.10 / $10,431.19 / $20,928.72
| Facility | | $4,078.10 | $10,431.19 | $20,928.72 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $582.01 / $582.01 / $582.01
| Facility | 54 | $582.01 | $582.01 | $582.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.01 / $1,284.64 / $4,227.17
| Professional | | $776.01 | $1,284.64 | $4,227.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,007.90 / $3,924.55 / $7,652.58
| Facility | | $3,007.90 | $3,924.55 | $7,652.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $746.83 / $1,273.01 / $1,697.34
| Professional | | $746.83 | $1,273.01 | $1,697.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,821.47 / $1,821.47 / $1,821.47
| Facility | | $1,821.47 | $1,821.47 | $1,821.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,621.18 / $1,901.78 / $2,377.23
| Professional | | $1,621.18 | $1,901.78 | $2,377.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $779.81 / $1,604.00 / $6,887.55
| Facility | | $779.81 | $1,604.00 | $6,887.55 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $4,569.92 / $4,569.92 / $4,569.92
| Facility | 54 | $4,569.92 | $4,569.92 | $4,569.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,057.93 / $1,597.91 / $2,107.81
| Professional | | $1,057.93 | $1,597.91 | $2,107.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,272.41 / $1,934.05 / $2,485.77
| Facility | | $1,272.41 | $1,934.05 | $2,485.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,163.14 / $1,621.18 / $2,219.42
| Professional | | $1,163.14 | $1,621.18 | $2,219.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,217.00 / $6,451.00 / $7,934.00
| Facility | | $4,217.00 | $6,451.00 | $7,934.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,197.69 / $1,693.78 / $2,082.04
| Professional | | $1,197.69 | $1,693.78 | $2,082.04 |