- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $3,162.28 / $9,772.37
| Facility | | $512.86 | $3,162.28 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $724.44 / $724.44 / $6,456.54
| Facility | 54 | $724.44 | $724.44 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $5,128.61 / $12,302.69
| Facility | | $1,659.59 | $5,128.61 | $12,302.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $1,288.25 / $3,548.13
| Facility | | $398.11 | $1,288.25 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $380.19 / $380.19 / $380.19
| Facility | 54 | $380.19 | $380.19 | $380.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $316.23 / $1,148.15 / $3,467.37
| Facility | | $316.23 | $1,148.15 | $3,467.37 |