- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $437.07 / $484.73 / $2,525.00
| Facility | | $437.07 | $484.73 | $2,525.00 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $327.80 / $363.55 / $363.55
| Facility | 54 | $327.80 | $363.55 | $363.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $423.87 / $484.73 / $723.68
| Professional | | $423.87 | $484.73 | $723.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,269.41 / $3,046.07 / $5,941.90
| Facility | | $1,269.41 | $3,046.07 | $5,941.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $804.99 / $1,279.58 / $1,715.07
| Professional | | $804.99 | $1,279.58 | $1,715.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,186.98 / $1,684.15 / $4,051.46
| Facility | | $1,186.98 | $1,684.15 | $4,051.46 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $515.25 / $515.25 / $515.25
| Facility | 54 | $515.25 | $515.25 | $515.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $833.21 / $1,372.92 / $2,078.28
| Professional | | $833.21 | $1,372.92 | $2,078.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,079.07 / $1,539.72 / $3,190.13
| Facility | | $1,079.07 | $1,539.72 | $3,190.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $805.42 / $1,208.98 / $1,865.54
| Professional | | $805.42 | $1,208.98 | $1,865.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $459.80 / $766.58 / $1,333.42
| Facility | | $459.80 | $766.58 | $1,333.42 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $1,414.67 / $1,414.67 / $1,414.67
| Facility | 54 | $1,414.67 | $1,414.67 | $1,414.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $509.68 / $951.89 / $3,238.64
| Professional | | $509.68 | $951.89 | $3,238.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,412.00 / $4,746.00 / $8,812.00
| Facility | | $2,412.00 | $4,746.00 | $8,812.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.26 / $932.81 / $1,771.75
| Professional | | $501.26 | $932.81 | $1,771.75 |