- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $728.13 / $2,095.00 / $7,838.38
| Facility | | $728.13 | $2,095.00 | $7,838.38 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $546.10 / $546.10 / $546.10
| Facility | 54 | $546.10 | $546.10 | $546.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,598.38 / $5,534.78 / $8,588.66
| Facility | | $1,598.38 | $5,534.78 | $8,588.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,800.00 / $3,800.00 / $3,800.00
| Facility | | $3,800.00 | $3,800.00 | $3,800.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $596.49 / $826.72 / $2,100.00
| Facility | | $596.49 | $826.72 | $2,100.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $639.00 / $5,971.00 / $8,422.00
| Facility | | $639.00 | $5,971.00 | $8,422.00 |