- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $606.69 / $2,520.00 / $6,681.00
| Facility | | $606.69 | $2,520.00 | $6,681.00 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $206.83 / $455.02 / $758.89
| Facility | 54 | $206.83 | $455.02 | $758.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $764.00 / $1,504.00 / $2,430.00
| Facility | | $764.00 | $1,504.00 | $2,430.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,206.19 / $2,244.48 / $26,542.00
| Facility | | $2,206.19 | $2,244.48 | $26,542.00 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $1,031.06 / $1,147.58 / $1,147.58
| Facility | 54 | $1,031.06 | $1,147.58 | $1,147.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $294.00 / $786.00 / $2,577.00
| Facility | | $294.00 | $786.00 | $2,577.00 |