- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $595.82 / $3,398.27 / $12,765.09
| Facility | | $595.82 | $3,398.27 | $12,765.09 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $283.89 / $283.89 / $1,386.24
| Facility | 54 | $283.89 | $283.89 | $1,386.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,312.63 / $3,041.74 / $5,883.72
| Facility | | $2,312.63 | $3,041.74 | $5,883.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,257.44 / $1,257.44 / $1,257.44
| Facility | | $1,257.44 | $1,257.44 | $1,257.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $378.53 / $662.43 / $3,044.00
| Facility | | $378.53 | $662.43 | $3,044.00 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $749.74 / $3,154.80 / $3,154.80
| Facility | 54 | $749.74 | $3,154.80 | $3,154.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $646.00 / $1,020.65 / $1,597.11
| Facility | | $646.00 | $1,020.65 | $1,597.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,992.24 / $2,719.50 / $7,772.00
| Facility | | $1,992.24 | $2,719.50 | $7,772.00 |