- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $788.78 / $1,831.00 / $3,705.34
| Facility | | $788.78 | $1,831.00 | $3,705.34 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $591.59 / $591.59 / $1,425.19
| Facility | 54 | $591.59 | $591.59 | $1,425.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,316.54 / $1,316.54 / $1,316.54
| Facility | | $1,316.54 | $1,316.54 | $1,316.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,256.23 / $1,388.79 / $3,047.67
| Facility | | $1,256.23 | $1,388.79 | $3,047.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $700.00 / $2,062.00 / $6,150.00
| Facility | | $700.00 | $2,062.00 | $6,150.00 |