- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,966.00 / $7,655.00 / $14,450.00
| Facility | | $2,966.00 | $7,655.00 | $14,450.00 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $783.89 / $783.89 / $1,156.09
| Facility | 54 | $783.89 | $783.89 | $1,156.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,594.10 / $3,726.84 / $5,510.56
| Facility | | $1,594.10 | $3,726.84 | $5,510.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.98 / $1,521.00 / $26,542.00
| Facility | | $870.98 | $1,521.00 | $26,542.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,418.00 / $3,096.00 / $5,565.00
| Facility | | $1,418.00 | $3,096.00 | $5,565.00 |