- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,876.70 / $5,012.08 / $7,904.39
| Facility | | $3,876.70 | $5,012.08 | $7,904.39 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $556.17 / $556.17 / $556.17
| Facility | 54 | $556.17 | $556.17 | $556.17 |
- Facility/Professional
- Facility
- Modifier
- 55
- Low / Median / High Price
- $111.24 / $111.24 / $111.24
| Facility | 55 | $111.24 | $111.24 | $111.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.57 / $939.17 / $1,512.84
| Professional | | $741.57 | $939.17 | $1,512.84 |
- Facility/Professional
- Professional
- Modifier
- 54
- Low / Median / High Price
- $513.20 / $556.17 / $973.41
| Professional | 54 | $513.20 | $556.17 | $973.41 |
- Facility/Professional
- Professional
- Modifier
- 55
- Low / Median / High Price
- $102.64 / $111.24 / $194.68
| Professional | 55 | $102.64 | $111.24 | $194.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $673.72 / $808.46 / $1,010.58
| Facility | | $673.72 | $808.46 | $1,010.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $673.72 / $808.46 / $1,562.06
| Professional | | $673.72 | $808.46 | $1,562.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $826.04 / $826.04 / $826.04
| Facility | | $826.04 | $826.04 | $826.04 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $577.02 / $577.02 / $577.02
| Facility | 54 | $577.02 | $577.02 | $577.02 |
- Facility/Professional
- Facility
- Modifier
- 55
- Low / Median / High Price
- $123.65 / $123.65 / $123.65
| Facility | 55 | $123.65 | $123.65 | $123.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $715.61 / $995.55 / $5,154.27
| Professional | | $715.61 | $995.55 | $5,154.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,643.88 / $5,987.28 / $9,197.95
| Facility | | $3,643.88 | $5,987.28 | $9,197.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,069.29 / $1,168.83 / $1,734.36
| Professional | | $1,069.29 | $1,168.83 | $1,734.36 |
- Facility/Professional
- Professional
- Modifier
- 54
- Low / Median / High Price
- $715.26 / $859.92 / $1,185.91
| Professional | 54 | $715.26 | $859.92 | $1,185.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.42 / $1,007.01 / $1,502.60
| Professional | | $575.42 | $1,007.01 | $1,502.60 |