- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $754.28 / $1,165.35 / $1,600.00
| Facility | | $754.28 | $1,165.35 | $1,600.00 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $565.71 / $565.71 / $874.02
| Facility | 54 | $565.71 | $565.71 | $874.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $804.65 / $902.48 / $983.27
| Facility | | $804.65 | $902.48 | $983.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $859.66 / $859.66 / $859.66
| Facility | | $859.66 | $859.66 | $859.66 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $596.32 / $596.32 / $596.32
| Facility | 54 | $596.32 | $596.32 | $596.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,487.03 / $4,487.03 / $4,487.03
| Facility | | $4,487.03 | $4,487.03 | $4,487.03 |