- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $580.00 / $1,520.00 / $3,685.00
| Facility | | $580.00 | $1,520.00 | $3,685.00 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $710.05 / $738.86 / $1,246.83
| Facility | 54 | $710.05 | $738.86 | $1,246.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,343.06 / $2,728.26 / $4,087.58
| Facility | | $1,343.06 | $2,728.26 | $4,087.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $40.00 / $699.97
| Facility | | $40.00 | $40.00 | $699.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $725.00 / $725.00 / $725.00
| Facility | | $725.00 | $725.00 | $725.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $341.00 / $1,086.00 / $2,755.00
| Facility | | $341.00 | $1,086.00 | $2,755.00 |