- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.68 / $924.70 / $6,906.00
| Facility | | $891.68 | $924.70 | $6,906.00 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $668.76 / $668.76 / $693.53
| Facility | 54 | $668.76 | $668.76 | $693.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,974.50 / $2,301.35 / $3,117.97
| Facility | | $1,974.50 | $2,301.35 | $3,117.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.68 / $891.68 / $6,906.00
| Facility | | $724.68 | $891.68 | $6,906.00 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $668.76 / $668.76 / $668.76
| Facility | 54 | $668.76 | $668.76 | $668.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,450.00 / $5,708.00 / $8,884.00
| Facility | | $1,450.00 | $5,708.00 | $8,884.00 |