- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $504.90 / $1,372.00 / $3,685.00
| Facility | | $504.90 | $1,372.00 | $3,685.00 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $366.02 / $393.85 / $639.01
| Facility | 54 | $366.02 | $393.85 | $639.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $583.77 / $1,418.82 / $3,277.85
| Facility | | $583.77 | $1,418.82 | $3,277.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $40.00 / $403.47
| Facility | | $40.00 | $40.00 | $403.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $725.00 / $725.00 / $725.00
| Facility | | $725.00 | $725.00 | $725.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $341.00 / $1,086.00 / $2,755.00
| Facility | | $341.00 | $1,086.00 | $2,755.00 |