- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $914.44 / $8,042.03 / $19,276.96
| Facility | | $914.44 | $8,042.03 | $19,276.96 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $215.69 / $215.69 / $333.11
| Facility | 54 | $215.69 | $215.69 | $333.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $528.12 / $694.62 / $1,343.62
| Facility | | $528.12 | $694.62 | $1,343.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $431.97 / $656.18 / $1,775.00
| Facility | | $431.97 | $656.18 | $1,775.00 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $1,031.06 / $1,031.06 / $1,031.06
| Facility | 54 | $1,031.06 | $1,031.06 | $1,031.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $491.47 / $780.40 / $1,303.08
| Facility | | $491.47 | $780.40 | $1,303.08 |
- 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 |