- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $932.00 / $2,836.02 / $6,483.00
| Facility | | $932.00 | $2,836.02 | $6,483.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $587.35 / $2,211.19 / $3,616.69
| Facility | | $587.35 | $2,211.19 | $3,616.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $457.09 / $603.22 / $3,134.00
| Facility | | $457.09 | $603.22 | $3,134.00 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $874.50 / $874.50 / $3,154.80
| Facility | 54 | $874.50 | $874.50 | $3,154.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.00 / $2,567.00 / $5,029.00
| Facility | | $1,584.00 | $2,567.00 | $5,029.00 |