- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $387.83 / $936.00 / $1,831.00
| Facility | | $387.83 | $936.00 | $1,831.00 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $269.04 / $290.87 / $651.79
| Facility | 54 | $269.04 | $290.87 | $651.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $926.90 / $926.90 / $926.90
| Facility | | $926.90 | $926.90 | $926.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $774.66 / $867.23 / $1,240.31
| Facility | | $774.66 | $867.23 | $1,240.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $455.00 / $870.00 / $3,779.00
| Facility | | $455.00 | $870.00 | $3,779.00 |