- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $497.07 / $2,324.00 / $6,907.00
| Facility | | $497.07 | $2,324.00 | $6,907.00 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $247.40 / $351.17 / $475.16
| Facility | 54 | $247.40 | $351.17 | $475.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,643.00 / $2,971.00 / $4,707.00
| Facility | | $1,643.00 | $2,971.00 | $4,707.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $521.47 / $537.13 / $657.50
| Facility | | $521.47 | $537.13 | $657.50 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $375.99 / $375.99 / $375.99
| Facility | 54 | $375.99 | $375.99 | $375.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $363.50 / $1,189.50 / $2,699.00
| Facility | | $363.50 | $1,189.50 | $2,699.00 |