- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $532.22 / $2,535.00 / $7,365.00
| Facility | | $532.22 | $2,535.00 | $7,365.00 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $307.05 / $307.05 / $430.47
| Facility | 54 | $307.05 | $307.05 | $430.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $821.00 / $1,963.00 / $4,852.00
| Facility | | $821.00 | $1,963.00 | $4,852.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $441.51 / $729.54 / $4,754.80
| Facility | | $441.51 | $729.54 | $4,754.80 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $874.50 / $874.50 / $3,154.80
| Facility | 54 | $874.50 | $874.50 | $3,154.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,216.00 / $2,306.00 / $3,071.00
| Facility | | $1,216.00 | $2,306.00 | $3,071.00 |