- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $658.55 / $2,778.87 / $7,205.00
| Facility | | $658.55 | $2,778.87 | $7,205.00 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $365.27 / $380.87 / $550.78
| Facility | 54 | $365.27 | $380.87 | $550.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.00 / $3,693.00 / $5,962.00
| Facility | | $1,905.00 | $3,693.00 | $5,962.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $725.00 / $835.58 / $1,153.31
| Facility | | $725.00 | $835.58 | $1,153.31 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $384.68 / $384.68 / $384.68
| Facility | 54 | $384.68 | $384.68 | $384.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,216.00 / $2,600.00 / $5,490.00
| Facility | | $1,216.00 | $2,600.00 | $5,490.00 |