- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,170.00 / $2,640.00 / $5,506.00
| Facility | | $1,170.00 | $2,640.00 | $5,506.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $412.80 / $1,640.88 / $2,700.74
| Facility | | $412.80 | $1,640.88 | $2,700.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $169.95 / $292.87 / $1,887.00
| Facility | | $169.95 | $292.87 | $1,887.00 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $445.65 / $445.65 / $651.70
| Facility | 54 | $445.65 | $445.65 | $651.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $716.00 / $1,535.00 / $2,175.00
| Facility | | $716.00 | $1,535.00 | $2,175.00 |