- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $690.86 / $2,145.78 / $7,838.38
| Facility | | $690.86 | $2,145.78 | $7,838.38 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $518.15 / $518.15 / $518.15
| Facility | 54 | $518.15 | $518.15 | $518.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $484.77 / $1,724.33 / $2,604.83
| Facility | | $484.77 | $1,724.33 | $2,604.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $624.70 / $825.19 / $1,021.68
| Facility | | $624.70 | $825.19 | $1,021.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $230.00 / $1,158.00 / $1,401.00
| Facility | | $230.00 | $1,158.00 | $1,401.00 |