- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $555.00 / $1,038.15 / $1,831.00
| Facility | | $555.00 | $1,038.15 | $1,831.00 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $321.38 / $321.38 / $778.61
| Facility | 54 | $321.38 | $321.38 | $778.61 |
- 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 / $2,000.95
| Facility | | $774.66 | $867.23 | $2,000.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $610.00 / $1,305.00 / $3,046.00
| Facility | | $610.00 | $1,305.00 | $3,046.00 |