- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $376.94 / $452.14 / $3,133.06
| Facility | | $376.94 | $452.14 | $3,133.06 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $376.94 / $376.94 / $376.94
| Facility | 54 | $376.94 | $376.94 | $376.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.12 / $483.06 / $526.30
| Facility | | $436.12 | $483.06 | $526.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $472.05 / $472.05 / $472.05
| Facility | | $472.05 | $472.05 | $472.05 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $328.83 / $328.83 / $328.83
| Facility | 54 | $328.83 | $328.83 | $328.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $639.60 / $2,903.11 / $7,683.35
| Facility | | $639.60 | $2,903.11 | $7,683.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,487.03 / $4,487.03 / $4,487.03
| Facility | | $4,487.03 | $4,487.03 | $4,487.03 |