- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $431.87 / $907.36 / $2,010.00
| Facility | | $431.87 | $907.36 | $2,010.00 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $212.27 / $323.89 / $680.52
| Facility | 54 | $212.27 | $323.89 | $680.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $290.14 / $290.14 / $290.14
| Facility | | $290.14 | $290.14 | $290.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $282.47 / $282.47 / $1,124.50
| Facility | | $282.47 | $282.47 | $1,124.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $225.00 / $513.00 / $1,581.00
| Facility | | $225.00 | $513.00 | $1,581.00 |