- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $3,090.30 / $7,413.10
| Facility | | $1,096.48 | $3,090.30 | $7,413.10 |
- 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
- $691.83 / $1,148.15 / $4,786.30
| Facility | | $691.83 | $1,148.15 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $1,318.26 / $3,162.28 / $3,162.28
| Facility | 54 | $1,318.26 | $3,162.28 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $1,202.26 / $2,238.72
| Facility | | $851.14 | $1,202.26 | $2,238.72 |