- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $761.96 / $1,965.00 / $5,506.00
| Facility | | $761.96 | $1,965.00 | $5,506.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $412.80 / $1,639.33 / $2,700.74
| Facility | | $412.80 | $1,639.33 | $2,700.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $339.18 / $423.47 / $1,221.00
| Facility | | $339.18 | $423.47 | $1,221.00 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $1,142.33 / $1,142.33 / $1,142.33
| Facility | 54 | $1,142.33 | $1,142.33 | $1,142.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $716.00 / $1,535.00 / $2,175.00
| Facility | | $716.00 | $1,535.00 | $2,175.00 |