- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $183.16 / $3,000.00 / $10,632.00
| Facility | | $183.16 | $3,000.00 | $10,632.00 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $115.56 / $122.78 / $137.37
| Facility | 54 | $115.56 | $122.78 | $137.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $126.73 / $128.77 / $323.00
| Facility | | $126.73 | $128.77 | $323.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,438.00 / $2,403.00 / $4,241.00
| Facility | | $1,438.00 | $2,403.00 | $4,241.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $366.00 / $1,950.00 / $5,107.00
| Facility | | $366.00 | $1,950.00 | $5,107.00 |