- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $212.53 / $462.53 / $2,056.00
| Facility | | $212.53 | $462.53 | $2,056.00 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $334.05 / $346.90 / $381.59
| Facility | 54 | $334.05 | $346.90 | $381.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $479.22 / $562.46 / $762.04
| Facility | | $479.22 | $562.46 | $762.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $212.53 / $470.85 / $4,933.00
| Facility | | $212.53 | $470.85 | $4,933.00 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $334.05 / $334.05 / $367.46
| Facility | 54 | $334.05 | $334.05 | $367.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $1,418.00 / $2,029.00
| Facility | | $300.00 | $1,418.00 | $2,029.00 |