- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $417.85 / $1,099.27 / $3,500.00
| Facility | | $417.85 | $1,099.27 | $3,500.00 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $313.39 / $342.12 / $548.51
| Facility | 54 | $313.39 | $342.12 | $548.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $265.35 / $492.94 / $970.87
| Facility | | $265.35 | $492.94 | $970.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $126.51 / $126.51 / $126.51
| Facility | | $126.51 | $126.51 | $126.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $425.00 / $425.00 / $425.00
| Facility | | $425.00 | $425.00 | $425.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $194.00 / $543.00 / $1,560.00
| Facility | | $194.00 | $543.00 | $1,560.00 |