- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $455.00 / $1,743.00 / $3,813.00
| Facility | | $455.00 | $1,743.00 | $3,813.00 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $315.58 / $358.58 / $525.91
| Facility | 54 | $315.58 | $358.58 | $525.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $543.66 / $1,043.58 / $2,357.19
| Facility | | $543.66 | $1,043.58 | $2,357.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $153.22 / $153.22 / $153.22
| Facility | | $153.22 | $153.22 | $153.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $194.00 / $513.00 / $1,226.00
| Facility | | $194.00 | $513.00 | $1,226.00 |