- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $714.00 / $5,839.00 / $12,444.00
| Facility | | $714.00 | $5,839.00 | $12,444.00 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $427.75 / $427.75 / $479.62
| Facility | 54 | $427.75 | $427.75 | $479.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $825.00 / $1,210.38 / $12,450.00
| Facility | | $825.00 | $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 |