- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $2,511.89 / $8,317.64
| Facility | | $524.81 | $2,511.89 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $630.96 / $977.24 / $8,511.38
| Facility | 54 | $630.96 | $977.24 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $3,890.45 / $10,000.00
| Facility | | $1,548.82 | $3,890.45 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $457.09 / $954.99 / $3,388.44
| Facility | | $457.09 | $954.99 | $3,388.44 |
- 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
- $302.00 / $1,258.93 / $3,981.07
| Facility | | $302.00 | $1,258.93 | $3,981.07 |