- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $322.55 / $3,795.64 / $13,841.56
| Facility | | $322.55 | $3,795.64 | $13,841.56 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $269.27 / $269.27 / $269.27
| Facility | 54 | $269.27 | $269.27 | $269.27 |
- 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
- $193.40 / $193.40 / $193.40
| Facility | | $193.40 | $193.40 | $193.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $359.03 / $626.88 / $1,242.00
| Facility | | $359.03 | $626.88 | $1,242.00 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $713.11 / $1,281.15 / $1,281.15
| Facility | 54 | $713.11 | $1,281.15 | $1,281.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $207.58 / $728.85 / $1,116.98
| Facility | | $207.58 | $728.85 | $1,116.98 |
- 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 |