- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $2,398.83 / $8,317.64
| Facility | | $467.74 | $2,398.83 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $524.81 / $758.58 / $1,548.82
| Facility | 54 | $524.81 | $758.58 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $3,630.78 / $8,709.64
| Facility | | $1,445.44 | $3,630.78 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.13 / $831.76 / $2,884.03
| Facility | | $331.13 | $831.76 | $2,884.03 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $467.74 / $467.74 / $467.74
| Facility | 54 | $467.74 | $467.74 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $204.17 / $1,071.52 / $3,467.37
| Facility | | $204.17 | $1,071.52 | $3,467.37 |