- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $932.00 / $2,260.00 / $5,506.00
| Facility | | $932.00 | $2,260.00 | $5,506.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $412.80 / $1,651.20 / $2,700.74
| Facility | | $412.80 | $1,651.20 | $2,700.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $394.52 / $525.40 / $1,887.00
| Facility | | $394.52 | $525.40 | $1,887.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $874.77 / $874.77 / $1,575.58
| Facility | 52 | $874.77 | $874.77 | $1,575.58 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $765.42 / $765.42 / $1,378.64
| Facility | 54 | $765.42 | $765.42 | $1,378.64 |
- 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 |