- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $407.38 / $446.68 / $446.68
| Facility | | $407.38 | $446.68 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $3,801.89 / $8,128.31
| Facility | | $1,548.82 | $3,801.89 | $8,128.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,659.59 / $3,890.45
| Facility | | $1,174.90 | $1,659.59 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $489.78 / $489.78 / $489.78
| Facility | 54 | $489.78 | $489.78 | $489.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $1,584.89 / $3,090.30
| Facility | | $1,258.93 | $1,584.89 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $407.38 / $724.44 / $1,318.26
| Facility | | $407.38 | $724.44 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,174.90 / $2,884.03 / $5,623.41
| Facility | | $1,174.90 | $2,884.03 | $5,623.41 |