- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $472.13 / $803.00 / $2,812.00
| Facility | | $472.13 | $803.00 | $2,812.00 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $347.78 / $374.53 / $436.34
| Facility | 54 | $347.78 | $374.53 | $436.34 |
- 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
- $483.82 / $483.82 / $483.82
| Facility | | $483.82 | $483.82 | $483.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $130.00 / $328.00 / $858.00
| Facility | | $130.00 | $328.00 | $858.00 |