- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.00 / $1,250.00 / $1,831.00
| Facility | | $645.00 | $1,250.00 | $1,831.00 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $510.81 / $510.81 / $1,237.53
| Facility | 54 | $510.81 | $510.81 | $1,237.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $926.90 / $926.90 / $926.90
| Facility | | $926.90 | $926.90 | $926.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $774.66 / $867.23 / $1,240.31
| Facility | | $774.66 | $867.23 | $1,240.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $455.00 / $858.00 / $1,957.00
| Facility | | $455.00 | $858.00 | $1,957.00 |