- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $947.27 / $2,877.00 / $7,212.00
| Facility | | $947.27 | $2,877.00 | $7,212.00 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $569.60 / $590.31 / $860.21
| Facility | 54 | $569.60 | $590.31 | $860.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,943.00 / $3,693.00 / $5,962.00
| Facility | | $1,943.00 | $3,693.00 | $5,962.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $852.66 / $867.23 / $1,193.57
| Facility | | $852.66 | $867.23 | $1,193.57 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $592.41 / $592.41 / $592.41
| Facility | 54 | $592.41 | $592.41 | $592.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $788.00 / $1,890.00 / $3,765.00
| Facility | | $788.00 | $1,890.00 | $3,765.00 |