- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $505.46 / $535.34 / $2,168.00
| Facility | | $505.46 | $535.34 | $2,168.00 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $379.10 / $401.51 / $401.51
| Facility | 54 | $379.10 | $401.51 | $401.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $458.40 / $527.49 / $793.67
| Professional | | $458.40 | $527.49 | $793.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $370.96 / $778.05 / $2,613.48
| Facility | | $370.96 | $778.05 | $2,613.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $923.28 / $1,466.10 / $1,900.42
| Professional | | $923.28 | $1,466.10 | $1,900.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,309.05 / $1,857.35 / $4,468.10
| Facility | | $1,309.05 | $1,857.35 | $4,468.10 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $598.88 / $598.88 / $598.88
| Facility | 54 | $598.88 | $598.88 | $598.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $949.04 / $1,564.61 / $2,323.69
| Professional | | $949.04 | $1,564.61 | $2,323.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,190.04 / $1,698.06 / $3,518.19
| Facility | | $1,190.04 | $1,698.06 | $3,518.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $889.25 / $1,351.09 / $2,123.11
| Professional | | $889.25 | $1,351.09 | $2,123.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $520.00 / $863.19 / $1,435.74
| Facility | | $520.00 | $863.19 | $1,435.74 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $1,639.31 / $1,639.31 / $1,639.31
| Facility | 54 | $1,639.31 | $1,639.31 | $1,639.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $571.82 / $1,077.04 / $3,747.28
| Professional | | $571.82 | $1,077.04 | $3,747.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $382.00 / $1,727.00 / $2,883.00
| Facility | | $382.00 | $1,727.00 | $2,883.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $587.39 / $1,030.56 / $1,963.78
| Professional | | $587.39 | $1,030.56 | $1,963.78 |