- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $443.27 / $1,064.00 / $2,812.00
| Facility | | $443.27 | $1,064.00 | $2,812.00 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $313.32 / $332.45 / $349.00
| Facility | 54 | $313.32 | $332.45 | $349.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $210.54 / $210.54 / $252.65
| Facility | | $210.54 | $210.54 | $252.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $483.82 / $483.82 / $483.82
| Facility | | $483.82 | $483.82 | $483.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $130.00 / $328.00 / $858.00
| Facility | | $130.00 | $328.00 | $858.00 |