- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $1,905.46 / $5,623.41
| Facility | | $537.03 | $1,905.46 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $1,819.70 / $4,168.69
| Facility | | $676.08 | $1,819.70 | $4,168.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $407.38 / $691.83 / $2,238.72
| Facility | | $407.38 | $691.83 | $2,238.72 |
- 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
- $346.74 / $724.44 / $1,778.28
| Facility | | $346.74 | $724.44 | $1,778.28 |