- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $698.33 / $2,341.64
| Facility | | $100.00 | $698.33 | $2,341.64 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $523.74 / $1,008.25 / $1,072.49
| Facility | 54 | $523.74 | $1,008.25 | $1,072.49 |
- 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
- $691.75 / $1,751.69 / $1,812.99
| Facility | | $691.75 | $1,751.69 | $1,812.99 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $484.22 / $484.22 / $484.22
| Facility | 54 | $484.22 | $484.22 | $484.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,035.00 / $8,035.00 / $8,035.00
| Facility | | $8,035.00 | $8,035.00 | $8,035.00 |