- 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
- $514.24 / $514.24 / $1,245.83
| Facility | 54 | $514.24 | $514.24 | $1,245.83 |
- 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 / $2,281.79
| Facility | | $774.66 | $867.23 | $2,281.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $610.00 / $1,536.00 / $4,738.30
| Facility | | $610.00 | $1,536.00 | $4,738.30 |