- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,074.00 / $4,419.35 / $8,031.00
| Facility | | $2,074.00 | $4,419.35 | $8,031.00 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $766.26 / $766.26 / $977.45
| Facility | 54 | $766.26 | $766.26 | $977.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,410.00 / $7,483.00 / $11,908.00
| Facility | | $5,410.00 | $7,483.00 | $11,908.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $550.00 / $2,296.86 / $2,296.86
| Facility | | $550.00 | $2,296.86 | $2,296.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,340.80 / $1,643.00 / $1,677.00
| Facility | | $1,340.80 | $1,643.00 | $1,677.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.00 / $3,075.00 / $6,664.00
| Facility | | $1,380.00 | $3,075.00 | $6,664.00 |