- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $470.82 / $2,778.87 / $6,915.00
| Facility | | $470.82 | $2,778.87 | $6,915.00 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $307.85 / $330.65 / $507.88
| Facility | 54 | $307.85 | $330.65 | $507.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,787.00 / $3,693.00 / $5,962.00
| Facility | | $1,787.00 | $3,693.00 | $5,962.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $691.75 / $761.81 / $1,009.20
| Facility | | $691.75 | $761.81 | $1,009.20 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $484.22 / $484.22 / $484.22
| Facility | 54 | $484.22 | $484.22 | $484.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $788.00 / $1,890.00 / $3,779.00
| Facility | | $788.00 | $1,890.00 | $3,779.00 |