- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $108.63 / $750.00 / $1,831.00
| Facility | | $108.63 | $750.00 | $1,831.00 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $62.40 / $81.47 / $174.71
| Facility | 54 | $62.40 | $81.47 | $174.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $89.61 / $89.61 / $89.61
| Facility | | $89.61 | $89.61 | $89.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $71.14 / $79.64 / $294.05
| Facility | | $71.14 | $79.64 | $294.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $225.00 / $513.00 / $1,739.00
| Facility | | $225.00 | $513.00 | $1,739.00 |