- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $705.38 / $2,359.52
| Facility | | $100.00 | $705.38 | $2,359.52 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $529.04 / $993.56 / $993.56
| Facility | 54 | $529.04 | $993.56 | $993.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,449.90 / $1,611.00 / $3,700.00
| Facility | | $1,449.90 | $1,611.00 | $3,700.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $472.05 / $1,306.21 / $1,351.93
| Facility | | $472.05 | $1,306.21 | $1,351.93 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $328.83 / $328.83 / $328.83
| Facility | 54 | $328.83 | $328.83 | $328.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,611.00 / $8,611.00 / $8,611.00
| Facility | | $8,611.00 | $8,611.00 | $8,611.00 |