- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,226.00 / $3,483.00 / $9,888.00
| Facility | | $1,226.00 | $3,483.00 | $9,888.00 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $181.25 / $193.33 / $231.91
| Facility | 54 | $181.25 | $193.33 | $231.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $192.95 / $277.54 / $403.03
| Professional | | $192.95 | $277.54 | $403.03 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $416.31 / $635.69 / $635.69
| Professional | 50 | $416.31 | $635.69 | $635.69 |
- Facility/Professional
- Professional
- Modifier
- 54
- Low / Median / High Price
- $120.16 / $181.25 / $302.27
| Professional | 54 | $120.16 | $181.25 | $302.27 |
- Facility/Professional
- Professional
- Modifier
- 55
- Low / Median / High Price
- $24.03 / $36.25 / $45.82
| Professional | 55 | $24.03 | $36.25 | $45.82 |
- 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
- $220.19 / $277.18 / $402.27
| Professional | | $220.19 | $277.18 | $402.27 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $281.97 / $330.28 / $359.01
| Professional | 50 | $281.97 | $330.28 | $359.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $209.98 / $330.94 / $496.84
| Professional | | $209.98 | $330.94 | $496.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $241.66 / $359.23 / $488.64
| Facility | | $241.66 | $359.23 | $488.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $221.52 / $314.04 / $405.84
| Professional | | $221.52 | $314.04 | $405.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,261.00 / $2,537.00 / $3,847.00
| Facility | | $1,261.00 | $2,537.00 | $3,847.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $286.01 / $375.99 / $620.74
| Professional | | $286.01 | $375.99 | $620.74 |