- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $349.38 / $388.86 / $2,168.00
| Facility | | $349.38 | $388.86 | $2,168.00 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $262.04 / $291.64 / $860.02
| Facility | 54 | $262.04 | $291.64 | $860.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $306.48 / $778.05 / $2,613.48
| Facility | | $306.48 | $778.05 | $2,613.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $951.27 / $1,349.71 / $3,246.91
| Facility | | $951.27 | $1,349.71 | $3,246.91 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $417.61 / $417.61 / $417.61
| Facility | 54 | $417.61 | $417.61 | $417.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $864.79 / $1,233.96 / $2,556.63
| Facility | | $864.79 | $1,233.96 | $2,556.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $343.70 / $616.07 / $1,027.81
| Facility | | $343.70 | $616.07 | $1,027.81 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $1,142.33 / $1,142.33 / $1,142.33
| Facility | 54 | $1,142.33 | $1,142.33 | $1,142.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $382.00 / $1,727.00 / $2,883.00
| Facility | | $382.00 | $1,727.00 | $2,883.00 |