- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $2,344.23 / $8,511.38
| Facility | | $1,023.29 | $2,344.23 | $8,511.38 |
- 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
- $1,318.26 / $1,318.26 / $1,318.26
| Facility | | $1,318.26 | $1,318.26 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $794.33 / $2,238.72
| Facility | | $489.78 | $794.33 | $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
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,174.90 / $1,479.11
| Professional | | $1,047.13 | $1,174.90 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $1,318.26 / $1,318.26
| Facility | | $1,318.26 | $1,318.26 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,819.70 / $4,466.84
| Facility | | $1,148.15 | $1,819.70 | $4,466.84 |