- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $4,570.88 / $7,585.78
| Facility | | $1,000.00 | $4,570.88 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $2,630.27 / $2,630.27 / $2,630.27
| Facility | 54 | $2,630.27 | $2,630.27 | $2,630.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $4,365.16 / $12,022.64
| Facility | | $3,715.35 | $4,365.16 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $741.31 / $2,290.87
| Facility | | $741.31 | $741.31 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $3,467.37 / $6,760.83
| Facility | | $1,288.25 | $3,467.37 | $6,760.83 |