- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $1,629.86 / $5,299.20
| Facility | | $100.00 | $1,629.86 | $5,299.20 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $602.72 / $1,222.40 / $1,337.58
| Facility | 54 | $602.72 | $1,222.40 | $1,337.58 |
- 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
- $801.14 / $1,751.69 / $1,812.99
| Facility | | $801.14 | $1,751.69 | $1,812.99 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $560.79 / $560.79 / $560.79
| Facility | 54 | $560.79 | $560.79 | $560.79 |
- 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 |