- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $860.20 / $1,831.00 / $2,825.00
| Facility | | $860.20 | $1,831.00 | $2,825.00 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $645.15 / $645.15 / $1,554.22
| Facility | 54 | $645.15 | $645.15 | $1,554.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $723.49 / $860.20 / $2,072.29
| Professional | | $723.49 | $860.20 | $2,072.29 |
- Facility/Professional
- Professional
- Modifier
- 55
- Low / Median / High Price
- $108.52 / $129.03 / $310.83
| Professional | 55 | $108.52 | $129.03 | $310.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,801.93 / $5,801.93 / $7,020.34
| Facility | | $5,801.93 | $5,801.93 | $7,020.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,062.64 / $1,062.64 / $1,062.64
| Professional | | $1,062.64 | $1,062.64 | $1,062.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,892.77 / $3,892.77 / $4,303.56
| Facility | | $3,892.77 | $3,892.77 | $4,303.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $796.14 / $1,108.83 / $2,027.32
| Professional | | $796.14 | $1,108.83 | $2,027.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $32.34
| Professional | | $32.34 | $32.34 | $32.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $985.00 / $3,572.00 / $10,251.00
| Facility | | $985.00 | $3,572.00 | $10,251.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $803.90 / $1,071.85 / $1,983.55
| Professional | | $803.90 | $1,071.85 | $1,983.55 |