- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $750.00 / $1,670.69 / $2,000.00
| Facility | | $750.00 | $1,670.69 | $2,000.00 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $520.13 / $520.13 / $1,253.02
| Facility | 54 | $520.13 | $520.13 | $1,253.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,316.54 / $1,316.54 / $1,316.54
| Facility | | $1,316.54 | $1,316.54 | $1,316.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,256.23 / $1,388.79 / $3,047.67
| Facility | | $1,256.23 | $1,388.79 | $3,047.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $700.00 / $2,062.00 / $6,150.00
| Facility | | $700.00 | $2,062.00 | $6,150.00 |