- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $362.43 / $2,218.00 / $8,652.00
| Facility | | $362.43 | $2,218.00 | $8,652.00 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $260.47 / $271.82 / $1,462.85
| Facility | 54 | $260.47 | $271.82 | $1,462.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $240.12 / $347.29 / $877.57
| Professional | | $240.12 | $347.29 | $877.57 |
- Facility/Professional
- Professional
- Modifier
- 54
- Low / Median / High Price
- $189.69 / $260.47 / $411.17
| Professional | 54 | $189.69 | $260.47 | $411.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,974.00 / $2,971.00 / $7,022.00
| Facility | | $1,974.00 | $2,971.00 | $7,022.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $353.65 / $474.77 / $767.25
| Professional | | $353.65 | $474.77 | $767.25 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $333.13 / $375.52 / $423.69
| Professional | 50 | $333.13 | $375.52 | $423.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $184.67 / $184.67 / $581.71
| Facility | | $184.67 | $184.67 | $581.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $289.04 / $427.38 / $659.98
| Professional | | $289.04 | $427.38 | $659.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $308.63 / $382.31 / $583.45
| Facility | | $308.63 | $382.31 | $583.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $381.67 / $508.90 / $710.50
| Professional | | $381.67 | $508.90 | $710.50 |
- Facility/Professional
- Professional
- Modifier
- 54
- Low / Median / High Price
- $577.66 / $577.66 / $602.85
| Professional | 54 | $577.66 | $577.66 | $602.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $730.00 / $1,491.00 / $2,720.00
| Facility | | $730.00 | $1,491.00 | $2,720.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $313.95 / $437.46 / $741.23
| Professional | | $313.95 | $437.46 | $741.23 |