- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $316.23 / $2,187.76 / $8,511.38
| Facility | | $316.23 | $2,187.76 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $398.11 / $851.14 / $851.14
| Facility | 54 | $398.11 | $851.14 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,388.44 / $4,365.16 / $8,511.38
| Facility | | $3,388.44 | $4,365.16 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $204.17 / $204.17 / $204.17
| Facility | | $204.17 | $204.17 | $204.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $354.81 / $575.44 / $1,230.27
| Facility | | $354.81 | $575.44 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $1,148.15 / $1,148.15 / $1,148.15
| Facility | 54 | $1,148.15 | $1,148.15 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $831.76 / $1,071.52
| Professional | | $758.58 | $831.76 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $204.17 / $204.17 / $204.17
| Facility | | $204.17 | $204.17 | $204.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $309.03 / $1,230.27 / $4,466.84
| Facility | | $309.03 | $1,230.27 | $4,466.84 |