- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $902.88 / $2,333.00 / $9,097.00
| Facility | | $902.88 | $2,333.00 | $9,097.00 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $665.00 / $677.16 / $728.39
| Facility | 54 | $665.00 | $677.16 | $728.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,196.23 / $2,196.23 / $2,635.48
| Facility | | $2,196.23 | $2,196.23 | $2,635.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,060.53 / $3,060.53 / $3,060.53
| Facility | | $3,060.53 | $3,060.53 | $3,060.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $980.00 / $1,650.00 / $4,064.00
| Facility | | $980.00 | $1,650.00 | $4,064.00 |