- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,039.72 / $4,908.03 / $8,031.00
| Facility | | $2,039.72 | $4,908.03 | $8,031.00 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $527.85 / $527.85 / $694.57
| Facility | 54 | $527.85 | $527.85 | $694.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,410.00 / $7,483.00 / $20,032.00
| Facility | | $5,410.00 | $7,483.00 | $20,032.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $737.00 / $2,296.86 / $2,296.86
| Facility | | $737.00 | $2,296.86 | $2,296.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,458.67 / $2,935.00 / $2,995.00
| Facility | | $2,458.67 | $2,935.00 | $2,995.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,614.00 / $5,307.00 / $8,879.00
| Facility | | $2,614.00 | $5,307.00 | $8,879.00 |