- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $668.00 / $5,797.00 / $11,624.00
| Facility | | $668.00 | $5,797.00 | $11,624.00 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $386.68 / $386.68 / $431.94
| Facility | 54 | $386.68 | $386.68 | $431.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.00 / $1,210.38 / $12,450.00
| Facility | | $630.00 | $1,210.38 | $12,450.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,105.00 / $5,731.00 / $11,037.00
| Facility | | $3,105.00 | $5,731.00 | $11,037.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,681.00 / $5,811.00 / $10,057.00
| Facility | | $1,681.00 | $5,811.00 | $10,057.00 |