- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $793.02 / $1,517.00 / $9,034.00
| Facility | | $793.02 | $1,517.00 | $9,034.00 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $586.58 / $594.77 / $641.09
| Facility | 54 | $586.58 | $594.77 | $641.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,196.23 / $2,196.23 / $2,635.48
| Facility | | $2,196.23 | $2,196.23 | $2,635.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,595.24 / $1,595.24 / $1,595.24
| Facility | | $1,595.24 | $1,595.24 | $1,595.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $980.00 / $1,650.00 / $4,064.00
| Facility | | $980.00 | $1,650.00 | $4,064.00 |