- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $249.32 / $2,100.00 / $5,506.00
| Facility | | $249.32 | $2,100.00 | $5,506.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $89.71 / $335.62 / $552.40
| Facility | | $89.71 | $335.62 | $552.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $92.70 / $129.65 / $1,053.00
| Facility | | $92.70 | $129.65 | $1,053.00 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $306.24 / $306.24 / $306.24
| Facility | 54 | $306.24 | $306.24 | $306.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $716.00 / $1,535.00 / $2,175.00
| Facility | | $716.00 | $1,535.00 | $2,175.00 |