- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $384.49 / $2,500.00 / $5,634.00
| Facility | | $384.49 | $2,500.00 | $5,634.00 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $288.37 / $288.37 / $477.54
| Facility | 54 | $288.37 | $288.37 | $477.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,636.00 / $3,840.00 / $7,747.00
| Facility | | $1,636.00 | $3,840.00 | $7,747.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $384.30 / $527.46 / $791.19
| Facility | | $384.30 | $527.46 | $791.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,123.45 / $1,123.45 / $1,331.74
| Facility | | $1,123.45 | $1,123.45 | $1,331.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,400.00 / $3,874.00 / $5,490.00
| Facility | | $2,400.00 | $3,874.00 | $5,490.00 |