- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $3,683.00 / $8,400.00
| Facility | | $1,000.00 | $3,683.00 | $8,400.00 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $596.60 / $596.60 / $596.60
| Facility | 54 | $596.60 | $596.60 | $596.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,206.73 / $3,505.71 / $5,538.99
| Facility | | $2,206.73 | $3,505.71 | $5,538.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,351.42 / $1,351.42 / $1,351.42
| Facility | | $1,351.42 | $1,351.42 | $1,351.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $689.77 / $1,036.09 / $3,502.45
| Facility | | $689.77 | $1,036.09 | $3,502.45 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $1,332.74 / $3,154.80 / $3,154.80
| Facility | 54 | $1,332.74 | $3,154.80 | $3,154.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $375.00 / $1,265.00 / $2,637.00
| Facility | | $375.00 | $1,265.00 | $2,637.00 |