- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $661.90 / $3,281.00 / $9,133.00
| Facility | | $661.90 | $3,281.00 | $9,133.00 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $431.78 / $482.23 / $628.54
| Facility | 54 | $431.78 | $482.23 | $628.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $984.20 / $1,450.76 / $2,299.67
| Facility | | $984.20 | $1,450.76 | $2,299.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $442.00 / $442.00 / $442.00
| Facility | | $442.00 | $442.00 | $442.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $455.53 / $679.56 / $1,457.41
| Facility | | $455.53 | $679.56 | $1,457.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $191.00 / $550.00 / $1,769.00
| Facility | | $191.00 | $550.00 | $1,769.00 |