- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $3,388.44 / $9,120.11
| Facility | | $724.44 | $3,388.44 | $9,120.11 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $478.63 / $1,479.11 / $2,137.96
| Facility | 54 | $478.63 | $1,479.11 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $4,168.69 / $10,000.00
| Facility | | $1,621.81 | $4,168.69 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $1,258.93 / $3,548.13
| Facility | | $575.44 | $1,258.93 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $575.44 / $575.44 / $575.44
| Facility | 54 | $575.44 | $575.44 | $575.44 |
- 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 |