- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $1,380.38 / $6,456.54
| Facility | | $489.78 | $1,380.38 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $1,737.80 / $2,818.38
| Facility | | $1,122.02 | $1,737.80 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $1,348.96 / $1,348.96
| Facility | | $1,348.96 | $1,348.96 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $457.09 / $630.96 / $2,511.89
| Facility | | $457.09 | $630.96 | $2,511.89 |
- 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
- $154.88 / $707.95 / $2,511.89
| Facility | | $154.88 | $707.95 | $2,511.89 |