- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $988.59 / $4,933.00 / $10,622.97
| Facility | | $988.59 | $4,933.00 | $10,622.97 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $741.44 / $741.44 / $768.91
| Facility | 54 | $741.44 | $741.44 | $768.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,550.42 / $2,972.61 / $4,027.41
| Facility | | $2,550.42 | $2,972.61 | $4,027.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $761.25 / $4,933.00 / $10,622.97
| Facility | | $761.25 | $4,933.00 | $10,622.97 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $741.44 / $741.44 / $741.44
| Facility | 54 | $741.44 | $741.44 | $741.44 |
- 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 |