- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $963.34 / $3,309.50 / $7,572.00
| Facility | | $963.34 | $3,309.50 | $7,572.00 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $573.67 / $596.77 / $871.02
| Facility | 54 | $573.67 | $596.77 | $871.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,943.00 / $3,931.00 / $7,344.00
| Facility | | $1,943.00 | $3,931.00 | $7,344.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $859.66 / $867.23 / $1,201.45
| Facility | | $859.66 | $867.23 | $1,201.45 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $596.32 / $596.32 / $596.32
| Facility | 54 | $596.32 | $596.32 | $596.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,320.00 / $3,105.02 / $5,510.00
| Facility | | $1,320.00 | $3,105.02 | $5,510.00 |