- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $593.00 / $1,520.00 / $3,779.00
| Facility | | $593.00 | $1,520.00 | $3,779.00 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $715.10 / $744.68 / $1,256.64
| Facility | 54 | $715.10 | $744.68 | $1,256.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $355.46 / $1,418.82 / $3,281.26
| Facility | | $355.46 | $1,418.82 | $3,281.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $732.78 / $1,984.11 / $1,984.11
| Facility | | $732.78 | $1,984.11 | $1,984.11 |
- 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
- $500.00 / $1,752.00 / $4,123.00
| Facility | | $500.00 | $1,752.00 | $4,123.00 |