- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $904.89 / $2,186.00 / $5,506.00
| Facility | | $904.89 | $2,186.00 | $5,506.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $438.60 / $1,651.20 / $2,700.74
| Facility | | $438.60 | $1,651.20 | $2,700.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $400.29 / $490.34 / $1,221.00
| Facility | | $400.29 | $490.34 | $1,221.00 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $1,347.91 / $1,347.91 / $1,347.91
| Facility | 54 | $1,347.91 | $1,347.91 | $1,347.91 |
- 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 |