- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $862.00 / $2,300.00 / $6,060.00
| Facility | | $862.00 | $2,300.00 | $6,060.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $438.60 / $1,651.20 / $2,700.74
| Facility | | $438.60 | $1,651.20 | $2,700.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $390.29 / $510.98 / $3,134.00
| Facility | | $390.29 | $510.98 | $3,134.00 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $749.74 / $749.74 / $3,154.80
| Facility | 54 | $749.74 | $749.74 | $3,154.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.00 / $2,567.00 / $5,029.00
| Facility | | $1,584.00 | $2,567.00 | $5,029.00 |