- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $941.00 / $2,758.00 / $5,432.00
| Facility | | $941.00 | $2,758.00 | $5,432.00 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $766.06 / $766.06 / $971.78
| Facility | 54 | $766.06 | $766.06 | $971.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,130.23 / $4,010.65 / $6,650.10
| Facility | | $2,130.23 | $4,010.65 | $6,650.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $40.00 / $40.00
| Facility | | $40.00 | $40.00 | $40.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,336.00 / $1,336.00 / $1,336.00
| Facility | | $1,336.00 | $1,336.00 | $1,336.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $746.00 / $2,415.00 / $6,585.00
| Facility | | $746.00 | $2,415.00 | $6,585.00 |