- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,051.24 / $5,700.00 / $12,424.00
| Facility | | $1,051.24 | $5,700.00 | $12,424.00 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $525.15 / $694.04 / $1,025.84
| Facility | 54 | $525.15 | $694.04 | $1,025.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,385.00 / $4,133.00 / $9,074.00
| Facility | | $2,385.00 | $4,133.00 | $9,074.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,073.45 / $3,183.00 / $13,009.50
| Facility | | $1,073.45 | $3,183.00 | $13,009.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.89 / $851.89 / $1,685.80
| Facility | | $851.89 | $851.89 | $1,685.80 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $596.32 / $596.32 / $596.32
| Facility | 54 | $596.32 | $596.32 | $596.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $332.00 / $801.19 / $7,533.00
| Facility | | $332.00 | $801.19 | $7,533.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,679.98 / $3,679.98 / $7,961.33
| Facility | | $3,679.98 | $3,679.98 | $7,961.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $555.00 / $851.89 / $74,999.25
| Facility | | $555.00 | $851.89 | $74,999.25 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $596.32 / $596.32 / $596.32
| Facility | 54 | $596.32 | $596.32 | $596.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,652.00 / $4,370.00 / $9,187.00
| Facility | | $1,652.00 | $4,370.00 | $9,187.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,041.93 / $1,041.93 / $2,088.38
| Facility | | $1,041.93 | $1,041.93 | $2,088.38 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $833.55 / $833.55 / $833.55
| Facility | 54 | $833.55 | $833.55 | $833.55 |