- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.18 / $1,295.00 / $3,804.00
| Facility | | $891.18 | $1,295.00 | $3,804.00 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $668.38 / $681.05 / $762.99
| Facility | 54 | $668.38 | $681.05 | $762.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,458.96 / $1,458.96 / $1,750.75
| Facility | | $1,458.96 | $1,458.96 | $1,750.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,543.14 / $1,543.14 / $1,543.14
| Facility | | $1,543.14 | $1,543.14 | $1,543.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $330.00 / $811.00 / $1,574.00
| Facility | | $330.00 | $811.00 | $1,574.00 |