- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $389.05 / $2,754.23 / $8,511.38
| Facility | | $389.05 | $2,754.23 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $398.11 / $1,380.38 / $1,380.38
| Facility | 54 | $398.11 | $1,380.38 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $3,630.78 / $8,709.64
| Facility | | $1,445.44 | $3,630.78 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $213.80 / $512.86 / $1,318.26
| Facility | | $213.80 | $512.86 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $218.78 / $218.78 / $218.78
| Facility | 54 | $218.78 | $218.78 | $218.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $204.17 / $1,071.52 / $3,467.37
| Facility | | $204.17 | $1,071.52 | $3,467.37 |