- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $502.42 / $3,392.00 / $7,996.00
| Facility | | $502.42 | $3,392.00 | $7,996.00 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $218.15 / $283.08 / $387.48
| Facility | 54 | $218.15 | $283.08 | $387.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $821.00 / $1,963.00 / $4,958.00
| Facility | | $821.00 | $1,963.00 | $4,958.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $329.38 / $572.09 / $3,064.00
| Facility | | $329.38 | $572.09 | $3,064.00 |
- 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
- $245.00 / $815.00 / $1,300.00
| Facility | | $245.00 | $815.00 | $1,300.00 |