- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.66 / $4,376.00 / $12,154.00
| Facility | | $758.66 | $4,376.00 | $12,154.00 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $296.44 / $394.57 / $604.52
| Facility | 54 | $296.44 | $394.57 | $604.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $825.00 / $1,742.29 / $2,109.33
| Facility | | $825.00 | $1,742.29 | $2,109.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $505.00 / $505.00 / $505.00
| Facility | | $505.00 | $505.00 | $505.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $339.26 / $502.42 / $2,244.48
| Facility | | $339.26 | $502.42 | $2,244.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $191.00 / $550.00 / $1,769.00
| Facility | | $191.00 | $550.00 | $1,769.00 |