- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $435.69 / $487.62 / $2,168.00
| Facility | | $435.69 | $487.62 | $2,168.00 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $326.77 / $365.72 / $365.72
| Facility | 54 | $326.77 | $365.72 | $365.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $394.14 / $476.26 / $742.21
| Professional | | $394.14 | $476.26 | $742.21 |
- 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
- $805.60 / $1,280.95 / $1,731.50
| Professional | | $805.60 | $1,280.95 | $1,731.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,195.40 / $1,696.10 / $4,080.19
| Facility | | $1,195.40 | $1,696.10 | $4,080.19 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $517.01 / $517.01 / $517.01
| Facility | 54 | $517.01 | $517.01 | $517.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $823.03 / $1,369.81 / $2,092.89
| Professional | | $823.03 | $1,369.81 | $2,092.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,086.73 / $1,550.64 / $3,212.75
| Facility | | $1,086.73 | $1,550.64 | $3,212.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $811.08 / $1,210.39 / $1,878.66
| Professional | | $811.08 | $1,210.39 | $1,878.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $475.59 / $787.59 / $1,343.54
| Facility | | $475.59 | $787.59 | $1,343.54 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $1,415.72 / $1,415.72 / $1,415.72
| Facility | 54 | $1,415.72 | $1,415.72 | $1,415.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $510.81 / $960.11 / $3,240.64
| Professional | | $510.81 | $960.11 | $3,240.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,187.00 / $2,872.00 / $4,241.00
| Facility | | $1,187.00 | $2,872.00 | $4,241.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $504.78 / $871.89 / $1,823.53
| Professional | | $504.78 | $871.89 | $1,823.53 |