- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,506.15 / $5,463.36 / $13,841.56
| Facility | | $1,506.15 | $5,463.36 | $13,841.56 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $466.97 / $466.97 / $466.97
| Facility | 54 | $466.97 | $466.97 | $466.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,350.61 / $4,406.97 / $8,524.51
| Facility | | $3,350.61 | $4,406.97 | $8,524.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,257.44 / $1,257.44 / $1,257.44
| Facility | | $1,257.44 | $1,257.44 | $1,257.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $622.63 / $1,089.59 / $2,666.19
| Facility | | $622.63 | $1,089.59 | $2,666.19 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $1,220.23 / $3,154.80 / $3,154.80
| Facility | 54 | $1,220.23 | $3,154.80 | $3,154.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $791.64 / $1,517.45 / $2,024.62
| Facility | | $791.64 | $1,517.45 | $2,024.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,031.00 / $1,775.00 / $4,406.00
| Facility | | $1,031.00 | $1,775.00 | $4,406.00 |