- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $577.26 / $5,371.66 / $9,080.76
| Facility | | $577.26 | $5,371.66 | $9,080.76 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $115.45 / $115.45 / $115.45
| Facility | 53 | $115.45 | $115.45 | $115.45 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $432.95 / $432.95 / $432.95
| Facility | 54 | $432.95 | $432.95 | $432.95 |
- Facility/Professional
- Facility
- Modifier
- 55
- Low / Median / High Price
- $86.59 / $86.59 / $86.59
| Facility | 55 | $86.59 | $86.59 | $86.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $431.31 / $598.63 / $1,195.43
| Professional | | $431.31 | $598.63 | $1,195.43 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $4,329.68 / $4,329.68 / $4,329.68
| Professional | 50 | $4,329.68 | $4,329.68 | $4,329.68 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $288.63 / $320.81 / $582.57
| Professional | 52 | $288.63 | $320.81 | $582.57 |
- Facility/Professional
- Professional
- Modifier
- 54
- Low / Median / High Price
- $410.80 / $481.22 / $823.14
| Professional | 54 | $410.80 | $481.22 | $823.14 |
- Facility/Professional
- Professional
- Modifier
- 55
- Low / Median / High Price
- $0.32 / $86.59 / $142.15
| Professional | 55 | $0.32 | $86.59 | $142.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,384.23 / $4,993.87 / $11,035.56
| Facility | | $2,384.23 | $4,993.87 | $11,035.56 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $5,313.75 / $8,062.11 / $14,136.20
| Facility | 50 | $5,313.75 | $8,062.11 | $14,136.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $847.86 / $1,152.26 / $1,893.38
| Professional | | $847.86 | $1,152.26 | $1,893.38 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $1,259.11 / $1,710.81 / $2,754.87
| Professional | 50 | $1,259.11 | $1,710.81 | $2,754.87 |
- Facility/Professional
- Professional
- Modifier
- 54
- Low / Median / High Price
- $678.29 / $915.41 / $1,469.26
| Professional | 54 | $678.29 | $915.41 | $1,469.26 |
- Facility/Professional
- Professional
- Modifier
- 55
- Low / Median / High Price
- $167.88 / $228.85 / $367.70
| Professional | 55 | $167.88 | $228.85 | $367.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,345.10 / $1,907.51 / $4,588.78
| Facility | | $1,345.10 | $1,907.51 | $4,588.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $913.01 / $1,491.00 / $2,560.81
| Professional | | $913.01 | $1,491.00 | $2,560.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,222.18 / $1,743.92 / $3,613.21
| Facility | | $1,222.18 | $1,743.92 | $3,613.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $801.99 / $1,272.65 / $2,166.25
| Professional | | $801.99 | $1,272.65 | $2,166.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $877.12 / $2,071.85 / $4,974.00
| Facility | | $877.12 | $2,071.85 | $4,974.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $795.19 / $1,131.39 / $2,936.02
| Professional | | $795.19 | $1,131.39 | $2,936.02 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $1,573.38 / $1,573.38 / $2,474.30
| Professional | 50 | $1,573.38 | $1,573.38 | $2,474.30 |
- Facility/Professional
- Professional
- Modifier
- 54
- Low / Median / High Price
- $752.21 / $800.92 / $1,110.90
| Professional | 54 | $752.21 | $800.92 | $1,110.90 |
- Facility/Professional
- Professional
- Modifier
- 55
- Low / Median / High Price
- $35.15 / $134.62 / $534.77
| Professional | 55 | $35.15 | $134.62 | $534.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,740.00 / $4,289.00 / $8,193.00
| Facility | | $2,740.00 | $4,289.00 | $8,193.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $641.22 / $1,091.01 / $2,035.17
| Professional | | $641.22 | $1,091.01 | $2,035.17 |