- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $2,884.03 / $7,244.36
| Facility | | $562.34 | $2,884.03 | $7,244.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $831.76 / $1,659.59
| Facility | | $436.52 | $831.76 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $562.34 / $562.34 / $562.34
| Facility | 54 | $562.34 | $562.34 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,691.53 / $4,786.30 / $9,549.93
| Facility | | $2,691.53 | $4,786.30 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.74 / $1,737.80 / $4,168.69
| Facility | | $346.74 | $1,737.80 | $4,168.69 |