- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $338.94 / $1,777.00 / $6,721.50
| Facility | | $338.94 | $1,777.00 | $6,721.50 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,361.34 / $2,054.48 / $2,054.48
| Facility | 50 | $1,361.34 | $2,054.48 | $2,054.48 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $191.06 / $232.13 / $340.56
| Facility | 54 | $191.06 | $232.13 | $340.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.20 / $303.60 / $585.69
| Professional | | $234.20 | $303.60 | $585.69 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $442.29 / $508.50 / $1,167.30
| Professional | 50 | $442.29 | $508.50 | $1,167.30 |
- Facility/Professional
- Professional
- Modifier
- 54
- Low / Median / High Price
- $175.65 / $228.14 / $356.64
| Professional | 54 | $175.65 | $228.14 | $356.64 |
- Facility/Professional
- Professional
- Modifier
- 55
- Low / Median / High Price
- $35.13 / $45.63 / $71.33
| Professional | 55 | $35.13 | $45.63 | $71.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,529.00 / $3,373.00 / $4,707.00
| Facility | | $1,529.00 | $3,373.00 | $4,707.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.75 / $346.06 / $562.99
| Professional | | $245.75 | $346.06 | $562.99 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $367.41 / $491.79 / $799.58
| Professional | 50 | $367.41 | $491.79 | $799.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $270.74 / $349.78 / $411.00
| Facility | | $270.74 | $349.78 | $411.00 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $271.12 / $271.12 / $271.12
| Facility | 54 | $271.12 | $271.12 | $271.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $240.62 / $388.19 / $639.52
| Professional | | $240.62 | $388.19 | $639.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $685.50 / $1,911.00 / $4,084.00
| Facility | | $685.50 | $1,911.00 | $4,084.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $282.08 / $389.41 / $657.44
| Professional | | $282.08 | $389.41 | $657.44 |