- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $3,090.30 / $6,760.83
| Facility | | $1,737.80 | $3,090.30 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $363.08 / $977.24
| Professional | | $269.15 | $363.08 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $346.74 / $1,000.00 / $2,187.76
| Professional | 50 | $346.74 | $1,000.00 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- 54
- Low / Median / High Price
- $288.40 / $316.23 / $575.44
| Professional | 54 | $288.40 | $316.23 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $288.40 / $323.59
| Professional | | $234.42 | $288.40 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $295.12 / $446.68 / $588.84
| Professional | 50 | $295.12 | $446.68 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $1,778.28 / $2,691.53
| Facility | | $549.54 | $1,778.28 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $309.03 / $602.56
| Professional | | $281.84 | $309.03 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $251.19 / $602.56 / $602.56
| Facility | | $251.19 | $602.56 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $331.13 / $724.44
| Professional | | $245.47 | $331.13 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $263.03 / $489.78 / $2,691.53
| Facility | | $263.03 | $489.78 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $977.24 / $977.24 / $977.24
| Facility | 54 | $977.24 | $977.24 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- 55
- Low / Median / High Price
- $208.93 / $208.93 / $208.93
| Facility | 55 | $208.93 | $208.93 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $371.54 / $2,511.89
| Professional | | $263.03 | $371.54 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $1,513.56 / $3,235.94
| Facility | | $467.74 | $1,513.56 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $302.00 / $501.19
| Professional | | $245.47 | $302.00 | $501.19 |