- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $627.44 / $1,568.05 / $3,050.89
| Facility | | $627.44 | $1,568.05 | $3,050.89 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $453.16 / $504.32 / $1,210.14
| Facility | 54 | $453.16 | $504.32 | $1,210.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,357.32 / $1,593.10 / $2,158.39
| Facility | | $1,357.32 | $1,593.10 | $2,158.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $627.44 / $1,808.10 / $3,050.89
| Facility | | $627.44 | $1,808.10 | $3,050.89 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $453.16 / $504.32 / $1,210.14
| Facility | 54 | $453.16 | $504.32 | $1,210.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $1,418.00 / $2,029.00
| Facility | | $300.00 | $1,418.00 | $2,029.00 |