- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $792.27 / $2,035.37
| Facility | | $100.00 | $792.27 | $2,035.37 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $448.58 / $924.80 / $2,168.64
| Facility | 54 | $448.58 | $924.80 | $2,168.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,223.09 / $1,359.00 / $3,300.00
| Facility | | $1,223.09 | $1,359.00 | $3,300.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $596.58 / $1,306.21 / $1,351.93
| Facility | | $596.58 | $1,306.21 | $1,351.93 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $417.61 / $417.61 / $417.61
| Facility | 54 | $417.61 | $417.61 | $417.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,448.00 / $7,448.00 / $7,448.00
| Facility | | $7,448.00 | $7,448.00 | $7,448.00 |