- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,070.00 / $2,897.00 / $6,483.00
| Facility | | $1,070.00 | $2,897.00 | $6,483.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $587.35 / $2,211.19 / $3,616.69
| Facility | | $587.35 | $2,211.19 | $3,616.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $395.94 / $492.50 / $1,497.00
| Facility | | $395.94 | $492.50 | $1,497.00 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $1,330.94 / $1,330.94 / $1,330.94
| Facility | 54 | $1,330.94 | $1,330.94 | $1,330.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,086.00 / $1,525.00 / $3,051.00
| Facility | | $1,086.00 | $1,525.00 | $3,051.00 |