- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $2,238.72 / $6,456.54
| Facility | | $933.25 | $2,238.72 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $1,778.28 / $2,691.53
| Facility | | $549.54 | $1,778.28 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $457.09 / $616.60 / $1,905.46
| Facility | | $457.09 | $616.60 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $1,548.82 / $1,548.82 / $1,548.82
| Facility | 54 | $1,548.82 | $1,548.82 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $1,380.38 / $2,187.76
| Facility | | $707.95 | $1,380.38 | $2,187.76 |