- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $399.32 / $877.04 / $1,831.00
| Facility | | $399.32 | $877.04 | $1,831.00 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $271.51 / $299.49 / $657.78
| Facility | 54 | $271.51 | $299.49 | $657.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $926.90 / $926.90 / $926.90
| Facility | | $926.90 | $926.90 | $926.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.82 / $774.66 / $958.74
| Facility | | $371.82 | $774.66 | $958.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $225.00 / $513.00 / $1,739.00
| Facility | | $225.00 | $513.00 | $1,739.00 |