- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,095.78 / $6,028.00 / $10,651.00
| Facility | | $2,095.78 | $6,028.00 | $10,651.00 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $658.54 / $658.54 / $658.54
| Facility | 54 | $658.54 | $658.54 | $658.54 |
- Facility/Professional
- Facility
- Modifier
- 55
- Low / Median / High Price
- $131.71 / $131.71 / $131.71
| Facility | 55 | $131.71 | $131.71 | $131.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $749.66 / $912.60 / $1,472.75
| Professional | | $749.66 | $912.60 | $1,472.75 |
- Facility/Professional
- Professional
- Modifier
- 54
- Low / Median / High Price
- $416.09 / $658.54 / $704.38
| Professional | 54 | $416.09 | $658.54 | $704.38 |
- Facility/Professional
- Professional
- Modifier
- 55
- Low / Median / High Price
- $83.22 / $131.71 / $140.88
| Professional | 55 | $83.22 | $131.71 | $140.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,434.00 / $5,126.00 / $9,729.00
| Facility | | $3,434.00 | $5,126.00 | $9,729.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $799.40 / $1,029.18 / $1,460.60
| Professional | | $799.40 | $1,029.18 | $1,460.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $718.14 / $1,077.39 / $1,561.75
| Professional | | $718.14 | $1,077.39 | $1,561.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $841.47 / $1,141.47 / $1,475.12
| Facility | | $841.47 | $1,141.47 | $1,475.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $768.30 / $1,017.08 / $1,375.61
| Professional | | $768.30 | $1,017.08 | $1,375.61 |
- Facility/Professional
- Professional
- Modifier
- 54
- Low / Median / High Price
- $1,229.27 / $1,229.27 / $1,229.27
| Professional | 54 | $1,229.27 | $1,229.27 | $1,229.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,645.00 / $6,090.00 / $14,057.00
| Facility | | $2,645.00 | $6,090.00 | $14,057.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $865.47 / $1,112.40 / $1,624.31
| Professional | | $865.47 | $1,112.40 | $1,624.31 |