- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $106.90 / $803.00 / $2,812.00
| Facility | | $106.90 | $803.00 | $2,812.00 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $77.97 / $95.19 / $111.07
| Facility | 54 | $77.97 | $95.19 | $111.07 |
- 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
- $167.26 / $167.26 / $167.26
| Facility | | $167.26 | $167.26 | $167.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $130.00 / $328.00 / $768.00
| Facility | | $130.00 | $328.00 | $768.00 |