- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $1,749.77 / $8,965.00
| Facility | | $100.00 | $1,749.77 | $8,965.00 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $864.05 / $1,848.92 / $1,848.92
| Facility | 54 | $864.05 | $1,848.92 | $1,848.92 |
- 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
- $778.31 / $1,306.21 / $1,351.93
| Facility | | $778.31 | $1,306.21 | $1,351.93 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $541.79 / $541.79 / $541.79
| Facility | 54 | $541.79 | $541.79 | $541.79 |
- 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 |