- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $378.64 / $1,821.00 / $6,681.00
| Facility | | $378.64 | $1,821.00 | $6,681.00 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $120.33 / $261.74 / $358.73
| Facility | 54 | $120.33 | $261.74 | $358.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $764.00 / $1,483.00 / $2,244.00
| Facility | | $764.00 | $1,483.00 | $2,244.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.00 / $30.00 / $30.00
| Facility | | $30.00 | $30.00 | $30.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $636.64 / $2,000.00 / $12,000.00
| Facility | | $636.64 | $2,000.00 | $12,000.00 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $445.65 / $651.70 / $651.70
| Facility | 54 | $445.65 | $651.70 | $651.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $294.00 / $808.00 / $2,577.00
| Facility | | $294.00 | $808.00 | $2,577.00 |