- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,346.00 / $4,195.00 / $15,445.01
| Facility | | $1,346.00 | $4,195.00 | $15,445.01 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $680.31 / $680.31 / $680.31
| Facility | 54 | $680.31 | $680.31 | $680.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $800.40 / $899.26 / $907.08
| Professional | | $800.40 | $899.26 | $907.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $921.55 / $921.55 / $921.55
| Professional | | $921.55 | $921.55 | $921.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,759.89 / $5,982.69 / $9,520.62
| Facility | | $3,759.89 | $5,982.69 | $9,520.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $772.80 / $1,001.99 / $1,061.17
| Professional | | $772.80 | $1,001.99 | $1,061.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,266.68 / $1,266.68 / $1,266.68
| Facility | | $1,266.68 | $1,266.68 | $1,266.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $583.82 / $926.82 / $1,122.15
| Professional | | $583.82 | $926.82 | $1,122.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $849.11 / $1,807.00 / $6,698.00
| Facility | | $849.11 | $1,807.00 | $6,698.00 |
- 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
- $649.33 / $796.32 / $1,770.87
| Professional | | $649.33 | $796.32 | $1,770.87 |
- 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
- $630.41 / $771.08 / $1,014.58
| Professional | | $630.41 | $771.08 | $1,014.58 |