- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.36 / $738.00 / $2,812.00
| Facility | | $398.36 | $738.00 | $2,812.00 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $292.82 / $312.13 / $385.07
| Facility | 54 | $292.82 | $312.13 | $385.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $210.54 / $210.54 / $252.65
| Facility | | $210.54 | $210.54 | $252.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $167.26 / $167.26 / $167.26
| Facility | | $167.26 | $167.26 | $167.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $130.00 / $328.00 / $768.00
| Facility | | $130.00 | $328.00 | $768.00 |