- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $477.55 / $1,543.03 / $6,130.77
| Facility | | $477.55 | $1,543.03 | $6,130.77 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $311.79 / $333.02 / $523.38
| Facility | 54 | $311.79 | $333.02 | $523.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,636.00 / $3,483.00 / $5,258.00
| Facility | | $1,636.00 | $3,483.00 | $5,258.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $665.66 / $699.73 / $994.74
| Facility | | $665.66 | $699.73 | $994.74 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $489.81 / $489.81 / $489.81
| Facility | 54 | $489.81 | $489.81 | $489.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $293.00 / $1,158.00 / $2,720.00
| Facility | | $293.00 | $1,158.00 | $2,720.00 |