- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $336.55 / $750.00 / $1,831.00
| Facility | | $336.55 | $750.00 | $1,831.00 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $229.73 / $252.41 / $556.55
| Facility | 54 | $229.73 | $252.41 | $556.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $141.65 / $141.65 / $141.65
| Facility | | $141.65 | $141.65 | $141.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $119.14 / $133.38 / $371.82
| Facility | | $119.14 | $133.38 | $371.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $225.00 / $513.00 / $1,739.00
| Facility | | $225.00 | $513.00 | $1,739.00 |