- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $387.74 / $2,507.00 / $7,365.00
| Facility | | $387.74 | $2,507.00 | $7,365.00 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $249.39 / $249.39 / $352.26
| Facility | 54 | $249.39 | $249.39 | $352.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $821.00 / $1,963.00 / $4,852.00
| Facility | | $821.00 | $1,963.00 | $4,852.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $349.15 / $556.19 / $1,546.88
| Facility | | $349.15 | $556.19 | $1,546.88 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $713.11 / $713.11 / $1,281.15
| Facility | 54 | $713.11 | $713.11 | $1,281.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $245.00 / $815.00 / $1,351.00
| Facility | | $245.00 | $815.00 | $1,351.00 |