- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $3,162.28 / $8,912.51
| Facility | | $549.54 | $3,162.28 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $524.81 / $524.81 / $1,122.02
| Facility | 54 | $524.81 | $524.81 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $4,265.80 / $10,000.00
| Facility | | $1,621.81 | $4,265.80 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $691.83 / $1,380.38 / $3,311.31
| Facility | | $691.83 | $1,380.38 | $3,311.31 |
- 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
- $660.69 / $2,041.74 / $4,897.79
| Facility | | $660.69 | $2,041.74 | $4,897.79 |