- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $508.98 / $727.15 / $6,781.00
| Facility | | $508.98 | $727.15 | $6,781.00 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $381.74 / $545.36 / $545.36
| Facility | 54 | $381.74 | $545.36 | $545.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $387.37 / $570.89 / $1,136.57
| Professional | | $387.37 | $570.89 | $1,136.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,116.64 / $3,744.92 / $8,304.51
| Facility | | $1,116.64 | $3,744.92 | $8,304.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $802.44 / $1,260.00 / $2,248.92
| Professional | | $802.44 | $1,260.00 | $2,248.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,684.50 / $2,390.06 / $5,749.62
| Facility | | $1,684.50 | $2,390.06 | $5,749.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $909.97 / $1,554.90 / $2,842.95
| Professional | | $909.97 | $1,554.90 | $2,842.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,370.08 / $2,185.09 / $4,527.26
| Facility | | $1,370.08 | $2,185.09 | $4,527.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $920.03 / $1,489.67 / $2,672.14
| Professional | | $920.03 | $1,489.67 | $2,672.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $542.09 / $982.70 / $4,746.00
| Facility | | $542.09 | $982.70 | $4,746.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $723.67 / $1,257.20 / $3,567.28
| Professional | | $723.67 | $1,257.20 | $3,567.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,735.00 / $4,974.00 / $8,812.00
| Facility | | $2,735.00 | $4,974.00 | $8,812.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $723.67 / $1,155.27 / $2,480.42
| Professional | | $723.67 | $1,155.27 | $2,480.42 |