- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $3,630.78 / $9,549.93
| Facility | | $1,023.29 | $3,630.78 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $3,090.30 / $3,090.30 / $3,090.30
| Facility | 54 | $3,090.30 | $3,090.30 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $5,011.87 / $10,964.78
| Facility | | $1,819.70 | $5,011.87 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $1,659.59 / $5,370.32
| Facility | | $831.76 | $1,659.59 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $891.25 / $891.25 / $891.25
| Facility | 54 | $891.25 | $891.25 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $2,041.74 / $4,897.79
| Facility | | $660.69 | $2,041.74 | $4,897.79 |