- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $932.00 / $2,186.00 / $5,506.00
| Facility | | $932.00 | $2,186.00 | $5,506.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $412.80 / $1,640.88 / $2,700.74
| Facility | | $412.80 | $1,640.88 | $2,700.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $362.29 / $486.22 / $1,868.00
| Facility | | $362.29 | $486.22 | $1,868.00 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $713.11 / $713.11 / $1,281.15
| Facility | 54 | $713.11 | $713.11 | $1,281.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $716.00 / $1,535.00 / $2,175.00
| Facility | | $716.00 | $1,535.00 | $2,175.00 |