- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $324.04 / $2,128.00 / $6,907.00
| Facility | | $324.04 | $2,128.00 | $6,907.00 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $135.62 / $151.81 / $222.12
| Facility | 54 | $135.62 | $151.81 | $222.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,529.00 / $2,479.00 / $4,441.52
| Facility | | $1,529.00 | $2,479.00 | $4,441.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $208.02 / $208.02 / $371.82
| Facility | | $208.02 | $208.02 | $371.82 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $140.13 / $140.13 / $140.13
| Facility | 54 | $140.13 | $140.13 | $140.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $293.00 / $1,158.00 / $2,720.00
| Facility | | $293.00 | $1,158.00 | $2,720.00 |