- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $3,467.37 / $8,709.64
| Facility | | $812.83 | $3,467.37 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $831.76 / $831.76 / $831.76
| Facility | 54 | $831.76 | $831.76 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $4,168.69 / $10,000.00
| Facility | | $1,621.81 | $4,168.69 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.96 / $1,659.59 / $4,265.80
| Facility | | $870.96 | $1,659.59 | $4,265.80 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $794.33 / $794.33 / $794.33
| Facility | 52 | $794.33 | $794.33 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $691.83 / $691.83 / $691.83
| Facility | 54 | $691.83 | $691.83 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $2,884.03 / $6,309.57
| Facility | | $1,000.00 | $2,884.03 | $6,309.57 |