- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $132.33 / $1,778.00 / $6,681.00
| Facility | | $132.33 | $1,778.00 | $6,681.00 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $70.81 / $91.11 / $141.22
| Facility | 54 | $70.81 | $91.11 | $141.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,529.00 / $2,971.00 / $4,707.00
| Facility | | $1,529.00 | $2,971.00 | $4,707.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $115.47 / $149.79 / $160.71
| Facility | | $115.47 | $149.79 | $160.71 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $112.50 / $112.50 / $112.50
| Facility | 54 | $112.50 | $112.50 | $112.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $293.00 / $1,158.00 / $2,720.00
| Facility | | $293.00 | $1,158.00 | $2,720.00 |