- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $558.65 / $1,181.00 / $3,109.00
| Facility | | $558.65 | $1,181.00 | $3,109.00 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $405.59 / $418.99 / $449.79
| Facility | 54 | $405.59 | $418.99 | $449.79 |
- 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 / $1,230.00 / $2,539.00
| Facility | | $590.00 | $1,230.00 | $2,539.00 |