- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $138.04 / $2,238.72 / $7,943.28
| Facility | | $138.04 | $2,238.72 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $141.25 / $141.25 / $141.25
| Facility | 54 | $141.25 | $141.25 | $141.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $3,715.35 / $9,549.93
| Facility | | $1,513.56 | $3,715.35 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $75.86 / $162.18 / $933.25
| Facility | | $75.86 | $162.18 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $112.20 / $112.20 / $112.20
| Facility | 54 | $112.20 | $112.20 | $112.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $204.17 / $1,071.52 / $3,467.37
| Facility | | $204.17 | $1,071.52 | $3,467.37 |