- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $356.23 / $1,083.00 / $3,109.00
| Facility | | $356.23 | $1,083.00 | $3,109.00 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $262.52 / $372.05 / $482.31
| Facility | 54 | $262.52 | $372.05 | $482.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $464.60 / $464.60 / $557.52
| Facility | | $464.60 | $464.60 | $557.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $768.90 / $768.90 / $768.90
| Facility | | $768.90 | $768.90 | $768.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $130.00 / $330.00 / $858.00
| Facility | | $130.00 | $330.00 | $858.00 |