- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $764.66 / $4,387.00 / $10,439.00
| Facility | | $764.66 | $4,387.00 | $10,439.00 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $440.10 / $440.10 / $573.50
| Facility | 54 | $440.10 | $440.10 | $573.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $757.15 / $1,114.26 / $1,767.27
| Facility | | $757.15 | $1,114.26 | $1,767.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $442.00 / $442.00 / $442.00
| Facility | | $442.00 | $442.00 | $442.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.00 / $764.66 / $3,331.00
| Facility | | $489.00 | $764.66 | $3,331.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $825.00 / $2,081.00 / $3,918.00
| Facility | | $825.00 | $2,081.00 | $3,918.00 |