- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $225.69 / $3,908.01 / $13,841.56
| Facility | | $225.69 | $3,908.01 | $13,841.56 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $148.38 / $148.38 / $169.27
| Facility | 54 | $148.38 | $148.38 | $169.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $196.43 / $225.69 / $1,047.00
| Professional | | $196.43 | $225.69 | $1,047.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,350.61 / $4,406.97 / $8,524.51
| Facility | | $3,350.61 | $4,406.97 | $8,524.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $209.47 / $356.27 / $476.08
| Professional | | $209.47 | $356.27 | $476.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $193.40 / $193.40 / $193.40
| Facility | | $193.40 | $193.40 | $193.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $320.45 / $504.08 / $685.66
| Professional | | $320.45 | $504.08 | $685.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $203.12 / $368.84 / $580.79
| Facility | | $203.12 | $368.84 | $580.79 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $701.49 / $701.49 / $701.49
| Facility | 54 | $701.49 | $701.49 | $701.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $291.24 / $484.10 / $1,612.40
| Professional | | $291.24 | $484.10 | $1,612.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $212.73 / $481.79 / $658.14
| Facility | | $212.73 | $481.79 | $658.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $394.00 / $482.75 / $656.99
| Professional | | $394.00 | $482.75 | $656.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,031.00 / $1,775.00 / $4,406.00
| Facility | | $1,031.00 | $1,775.00 | $4,406.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $291.24 / $484.10 / $627.28
| Professional | | $291.24 | $484.10 | $627.28 |