- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $374.89 / $597.07 / $1,200.00
| Facility | | $374.89 | $597.07 | $1,200.00 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $281.17 / $281.17 / $447.80
| Facility | 54 | $281.17 | $281.17 | $447.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.63 / $462.40 / $503.78
| Facility | | $416.63 | $462.40 | $503.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $449.73 / $449.73 / $449.73
| Facility | | $449.73 | $449.73 | $449.73 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $313.17 / $313.17 / $313.17
| Facility | 54 | $313.17 | $313.17 | $313.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,457.11 / $1,457.11 / $1,457.11
| Facility | | $1,457.11 | $1,457.11 | $1,457.11 |