- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $1,348.46 / $6,927.30
| Facility | | $100.00 | $1,348.46 | $6,927.30 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $530.79 / $1,011.35 / $1,105.46
| Facility | 54 | $530.79 | $1,011.35 | $1,105.46 |
- 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
- $699.73 / $1,306.21 / $1,351.93
| Facility | | $699.73 | $1,306.21 | $1,351.93 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $489.81 / $489.81 / $489.81
| Facility | 54 | $489.81 | $489.81 | $489.81 |
- 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 |