- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,929.86 / $6,560.00 / $13,151.00
| Facility | | $1,929.86 | $6,560.00 | $13,151.00 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $1,114.68 / $1,114.68 / $1,447.40
| Facility | 54 | $1,114.68 | $1,114.68 | $1,447.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,831.00 / $3,829.41 / $6,069.38
| Facility | | $2,831.00 | $3,829.41 | $6,069.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $624.00 / $624.00 / $624.00
| Facility | | $624.00 | $624.00 | $624.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,073.89 / $1,782.24 / $4,960.00
| Facility | | $1,073.89 | $1,782.24 | $4,960.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,967.00 / $4,960.00 / $11,732.00
| Facility | | $1,967.00 | $4,960.00 | $11,732.00 |