- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $468.34 / $1,074.00 / $3,109.00
| Facility | | $468.34 | $1,074.00 | $3,109.00 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $346.16 / $371.80 / $433.20
| Facility | 54 | $346.16 | $371.80 | $433.20 |
- 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
- $483.82 / $483.82 / $483.82
| Facility | | $483.82 | $483.82 | $483.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $330.00 / $811.00 / $1,574.00
| Facility | | $330.00 | $811.00 | $1,574.00 |