- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $281.12 / $2,747.00 / $4,806.64
| Facility | | $281.12 | $2,747.00 | $4,806.64 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $210.84 / $210.84 / $225.86
| Facility | 54 | $210.84 | $210.84 | $225.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $271.11 / $325.69 / $773.09
| Professional | | $271.11 | $325.69 | $773.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $360.87 / $818.35 / $2,713.00
| Facility | | $360.87 | $818.35 | $2,713.00 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $1,157.40 / $1,157.40 / $1,157.40
| Facility | 54 | $1,157.40 | $1,157.40 | $1,157.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $308.58 / $635.04 / $2,482.40
| Professional | | $308.58 | $635.04 | $2,482.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $386.99 / $497.28 / $887.76
| Facility | | $386.99 | $497.28 | $887.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $443.94 / $661.10 / $868.93
| Professional | | $443.94 | $661.10 | $868.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.00 / $50.00 / $50.00
| Facility | | $50.00 | $50.00 | $50.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.41 / $548.16 / $939.65
| Professional | | $331.41 | $548.16 | $939.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $214.32 / $493.95 / $6,679.00
| Facility | | $214.32 | $493.95 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $399.28 / $486.37 / $671.39
| Professional | | $399.28 | $486.37 | $671.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $396.90 / $786.81 / $1,024.74
| Professional | | $396.90 | $786.81 | $1,024.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.23 / $398.23 / $398.23
| Professional | | $398.23 | $398.23 | $398.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $1,653.43 / $3,445.00
| Facility | | $55.00 | $1,653.43 | $3,445.00 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $1,157.40 / $1,157.40 / $1,157.40
| Facility | 54 | $1,157.40 | $1,157.40 | $1,157.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $351.25 / $671.28 / $2,482.40
| Professional | | $351.25 | $671.28 | $2,482.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $627.00 / $1,818.00 / $2,733.00
| Facility | | $627.00 | $1,818.00 | $2,733.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $335.35 / $527.88 / $1,050.21
| Professional | | $335.35 | $527.88 | $1,050.21 |