- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $827.82 / $7,838.38 / $8,942.39
| Facility | | $827.82 | $7,838.38 | $8,942.39 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $620.87 / $620.87 / $620.87
| Facility | 54 | $620.87 | $620.87 | $620.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,066.57 / $10,618.71 / $16,477.70
| Facility | | $3,066.57 | $10,618.71 | $16,477.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,100.00 / $6,100.00 / $6,100.00
| Facility | | $6,100.00 | $6,100.00 | $6,100.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $944.18 / $3,150.00
| Facility | | $676.08 | $944.18 | $3,150.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $639.00 / $5,971.00 / $8,422.00
| Facility | | $639.00 | $5,971.00 | $8,422.00 |