- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $738.00 / $1,070.00 / $2,812.00
| Facility | | $738.00 | $1,070.00 | $2,812.00 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $612.50 / $614.45 / $702.13
| Facility | 54 | $612.50 | $614.45 | $702.13 |
- 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
- $483.82 / $483.82 / $483.82
| Facility | | $483.82 | $483.82 | $483.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $130.00 / $328.00 / $768.00
| Facility | | $130.00 | $328.00 | $768.00 |