- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $908.61 / $908.61 / $9,500.00
| Facility | | $908.61 | $908.61 | $9,500.00 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $681.46 / $681.46 / $681.46
| Facility | 54 | $681.46 | $681.46 | $681.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $711.73 / $860.91 / $1,426.38
| Professional | | $711.73 | $860.91 | $1,426.38 |
- Facility/Professional
- Professional
- Modifier
- 55
- Low / Median / High Price
- $136.29 / $143.58 / $143.58
| Professional | 55 | $136.29 | $143.58 | $143.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,719.07 / $1,878.16 / $2,219.06
| Professional | | $1,719.07 | $1,878.16 | $2,219.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.03 / $1,664.52 / $2,784.87
| Professional | | $851.03 | $1,664.52 | $2,784.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $908.61 / $1,187.41 / $2,471.00
| Facility | | $908.61 | $1,187.41 | $2,471.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $862.75 / $1,638.34 / $2,371.73
| Professional | | $862.75 | $1,638.34 | $2,371.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,545.00 / $2,545.00 / $2,545.00
| Facility | | $2,545.00 | $2,545.00 | $2,545.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $925.34 / $1,456.30 / $2,455.73
| Professional | | $925.34 | $1,456.30 | $2,455.73 |