- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.08 / $1,273.00 / $3,500.00
| Facility | | $302.08 | $1,273.00 | $3,500.00 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $178.82 / $188.31 / $317.77
| Facility | 54 | $178.82 | $188.31 | $317.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $265.35 / $492.94 / $970.87
| Facility | | $265.35 | $492.94 | $970.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $40.00 / $171.58
| Facility | | $40.00 | $40.00 | $171.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $425.00 / $425.00 / $425.00
| Facility | | $425.00 | $425.00 | $425.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $194.00 / $543.00 / $1,560.00
| Facility | | $194.00 | $543.00 | $1,560.00 |