- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $2,630.27 / $8,317.64
| Facility | | $562.34 | $2,630.27 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $1,318.26 / $1,659.59 / $2,570.40
| Facility | 54 | $1,318.26 | $1,659.59 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $4,168.69 / $10,000.00
| Facility | | $1,548.82 | $4,168.69 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $691.83 / $1,318.26 / $3,019.95
| Facility | | $691.83 | $1,318.26 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $489.78 / $489.78 / $489.78
| Facility | 54 | $489.78 | $489.78 | $489.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $2,884.03 / $6,309.57
| Facility | | $1,000.00 | $2,884.03 | $6,309.57 |