- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $465.63 / $1,140.00 / $2,546.25
| Facility | | $465.63 | $1,140.00 | $2,546.25 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $314.67 / $349.22 / $762.34
| Facility | 54 | $314.67 | $349.22 | $762.34 |
- 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 |