- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $466.46 / $1,064.00 / $2,812.00
| Facility | | $466.46 | $1,064.00 | $2,812.00 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $338.39 / $357.59 / $371.56
| Facility | 54 | $338.39 | $357.59 | $371.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,458.96 / $1,458.96 / $1,750.75
| Facility | | $1,458.96 | $1,458.96 | $1,750.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,543.14 / $1,543.14 / $1,543.14
| Facility | | $1,543.14 | $1,543.14 | $1,543.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $590.00 / $1,427.00 / $4,537.46
| Facility | | $590.00 | $1,427.00 | $4,537.46 |