- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $2,630.27 / $6,606.93
| Facility | | $1,000.00 | $2,630.27 | $6,606.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $3,235.94 / $5,370.32
| Facility | | $2,089.30 | $3,235.94 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $1,348.96 / $1,348.96
| Facility | | $1,348.96 | $1,348.96 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $1,047.13 / $3,981.07
| Facility | | $676.08 | $1,047.13 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $1,318.26 / $3,162.28 / $3,162.28
| Facility | 54 | $1,318.26 | $3,162.28 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $478.63 / $1,318.26 / $2,691.53
| Facility | | $478.63 | $1,318.26 | $2,691.53 |