- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $638.22 / $2,512.57 / $4,933.00
| Facility | | $638.22 | $2,512.57 | $4,933.00 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $460.94 / $460.94 / $478.67
| Facility | 54 | $460.94 | $460.94 | $478.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,532.18 / $1,798.32 / $2,436.44
| Facility | | $1,532.18 | $1,798.32 | $2,436.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $474.51 / $2,512.57 / $4,933.00
| Facility | | $474.51 | $2,512.57 | $4,933.00 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $460.94 / $460.94 / $460.94
| Facility | 54 | $460.94 | $460.94 | $460.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,050.00 / $3,640.00 / $6,327.00
| Facility | | $1,050.00 | $3,640.00 | $6,327.00 |