- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $900.00 / $2,636.00 / $5,432.00
| Facility | | $900.00 | $2,636.00 | $5,432.00 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $742.25 / $742.25 / $940.89
| Facility | 54 | $742.25 | $742.25 | $940.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,371.65 / $3,826.81 / $5,947.72
| Facility | | $2,371.65 | $3,826.81 | $5,947.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,950.97 / $1,950.97 / $1,950.97
| Facility | | $1,950.97 | $1,950.97 | $1,950.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,124.00 / $1,124.00 / $1,124.00
| Facility | | $1,124.00 | $1,124.00 | $1,124.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $746.00 / $2,415.00 / $6,585.00
| Facility | | $746.00 | $2,415.00 | $6,585.00 |