- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $688.42 / $2,145.78 / $6,915.00
| Facility | | $688.42 | $2,145.78 | $6,915.00 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $478.13 / $535.91 / $760.53
| Facility | 54 | $478.13 | $535.91 | $760.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $523.44 / $707.96 / $1,276.88
| Professional | | $523.44 | $707.96 | $1,276.88 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $1,659.48 / $1,659.48 / $1,780.93
| Professional | 50 | $1,659.48 | $1,659.48 | $1,780.93 |
- Facility/Professional
- Professional
- Modifier
- 54
- Low / Median / High Price
- $438.29 / $545.99 / $817.37
| Professional | 54 | $438.29 | $545.99 | $817.37 |
- Facility/Professional
- Professional
- Modifier
- 55
- Low / Median / High Price
- $87.66 / $109.20 / $163.47
| Professional | 55 | $87.66 | $109.20 | $163.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,682.00 / $3,693.00 / $5,962.00
| Facility | | $1,682.00 | $3,693.00 | $5,962.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $546.28 / $714.77 / $1,176.86
| Professional | | $546.28 | $714.77 | $1,176.86 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $831.57 / $1,025.78 / $1,476.45
| Professional | 50 | $831.57 | $1,025.78 | $1,476.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $500.74 / $531.64 / $743.96
| Facility | | $500.74 | $531.64 | $743.96 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $695.92 / $695.92 / $695.92
| Facility | 54 | $695.92 | $695.92 | $695.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $548.00 / $789.34 / $1,377.76
| Professional | | $548.00 | $789.34 | $1,377.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,086.50 / $2,572.00 / $5,500.00
| Facility | | $1,086.50 | $2,572.00 | $5,500.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $594.99 / $775.55 / $1,365.98
| Professional | | $594.99 | $775.55 | $1,365.98 |