- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $554.16 / $1,083.00 / $3,109.00
| Facility | | $554.16 | $1,083.00 | $3,109.00 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $415.63 / $451.83 / $512.60
| Facility | 54 | $415.63 | $451.83 | $512.60 |
- 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 / $768.00
| Facility | | $130.00 | $328.00 | $768.00 |