- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $3,981.07 / $9,332.54
| Facility | | $776.25 | $3,981.07 | $9,332.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $831.76 / $1,659.59
| Facility | | $436.52 | $831.76 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $575.44 / $575.44 / $575.44
| Facility | 54 | $575.44 | $575.44 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,691.53 / $4,786.30 / $9,549.93
| Facility | | $2,691.53 | $4,786.30 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $3,548.13 / $6,760.83
| Facility | | $1,023.29 | $3,548.13 | $6,760.83 |