- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $572.44 / $1,454.37 / $2,678.80
| Facility | | $572.44 | $1,454.37 | $2,678.80 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $646.96 / $766.32 / $1,090.78
| Facility | 54 | $646.96 | $766.32 | $1,090.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,223.09 / $1,359.00 / $3,300.00
| Facility | | $1,223.09 | $1,359.00 | $3,300.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,000.36 / $2,000.36 / $2,070.38
| Facility | | $2,000.36 | $2,000.36 | $2,070.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,448.00 / $7,448.00 / $7,448.00
| Facility | | $7,448.00 | $7,448.00 | $7,448.00 |