- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,458.71 / $2,897.00 / $6,483.00
| Facility | | $1,458.71 | $2,897.00 | $6,483.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $587.35 / $2,211.19 / $3,616.69
| Facility | | $587.35 | $2,211.19 | $3,616.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $703.14 / $942.77 / $2,710.00
| Facility | | $703.14 | $942.77 | $2,710.00 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $1,332.74 / $1,332.74 / $3,154.80
| Facility | 54 | $1,332.74 | $1,332.74 | $3,154.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,086.00 / $1,525.00 / $3,268.00
| Facility | | $1,086.00 | $1,525.00 | $3,268.00 |