- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $125.89 / $1,698.24 / $7,943.28
| Facility | | $125.89 | $1,698.24 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $75.86 / $162.18
| Facility | | $34.67 | $75.86 | $162.18 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $112.20 / $112.20 / $112.20
| Facility | 54 | $112.20 | $112.20 | $112.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $2,454.71 / $4,168.69
| Facility | | $1,513.56 | $2,454.71 | $4,168.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $269.15 / $1,584.89 / $4,168.69
| Facility | | $269.15 | $1,584.89 | $4,168.69 |