- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $303.72 / $671.15 / $6,735.00
| Facility | | $303.72 | $671.15 | $6,735.00 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $227.79 / $352.08 / $510.74
| Facility | 54 | $227.79 | $352.08 | $510.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $303.72 / $469.44 / $701.03
| Facility | | $303.72 | $469.44 | $701.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $361.00 / $896.00 / $2,229.00
| Facility | | $361.00 | $896.00 | $2,229.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,206.19 / $2,206.19 / $26,542.00
| Facility | | $2,206.19 | $2,206.19 | $26,542.00 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $1,147.58 / $1,147.58 / $1,147.58
| Facility | 54 | $1,147.58 | $1,147.58 | $1,147.58 |