- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $896.00 / $3,382.00 / $7,467.00
| Facility | | $896.00 | $3,382.00 | $7,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $632.79 / $2,531.19 / $4,140.09
| Facility | | $632.79 | $2,531.19 | $4,140.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $298.12 / $455.85 / $1,689.00
| Facility | | $298.12 | $455.85 | $1,689.00 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $1,031.06 / $1,031.06 / $1,031.06
| Facility | 54 | $1,031.06 | $1,031.06 | $1,031.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $704.00 / $1,535.00 / $2,326.00
| Facility | | $704.00 | $1,535.00 | $2,326.00 |