- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $876.18 / $1,821.00 / $3,324.00
| Facility | | $876.18 | $1,821.00 | $3,324.00 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $636.04 / $657.14 / $699.66
| Facility | 54 | $636.04 | $657.14 | $699.66 |
- 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
- $2,450.89 / $2,450.89 / $2,450.89
| Facility | | $2,450.89 | $2,450.89 | $2,450.89 |
- 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 |