- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $177.92 / $1,791.00 / $6,681.00
| Facility | | $177.92 | $1,791.00 | $6,681.00 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $61.35 / $133.44 / $189.78
| Facility | 54 | $61.35 | $133.44 | $189.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $764.00 / $1,487.00 / $2,244.00
| Facility | | $764.00 | $1,487.00 | $2,244.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.00 / $30.00 / $30.00
| Facility | | $30.00 | $30.00 | $30.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $482.46 / $482.46
| Facility | | $55.00 | $482.46 | $482.46 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $306.24 / $337.72 / $337.72
| Facility | 54 | $306.24 | $337.72 | $337.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $294.00 / $808.00 / $2,577.00
| Facility | | $294.00 | $808.00 | $2,577.00 |