- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.43 / $1,305.00 / $4,799.53
| Facility | | $912.43 | $1,305.00 | $4,799.53 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $684.32 / $691.98 / $799.83
| Facility | 54 | $684.32 | $691.98 | $799.83 |
- 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
- $1,856.35 / $1,856.35 / $1,856.35
| Facility | | $1,856.35 | $1,856.35 | $1,856.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $600.00 / $1,427.00 / $4,537.46
| Facility | | $600.00 | $1,427.00 | $4,537.46 |