- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $3,715.35 / $7,413.10
| Facility | | $501.19 | $3,715.35 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $501.19 / $602.56
| Facility | | $501.19 | $501.19 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $794.33 / $1,659.59
| Facility | | $794.33 | $794.33 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $562.34 / $562.34 / $562.34
| Facility | 54 | $562.34 | $562.34 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $5,754.40 / $7,762.47
| Facility | | $1,737.80 | $5,754.40 | $7,762.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $457.09 / $457.09 / $4,466.84
| Facility | | $457.09 | $457.09 | $4,466.84 |