- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $4,786.30 / $11,481.54
| Facility | | $1,096.48 | $4,786.30 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,630.27 / $7,413.10 / $14,791.08
| Facility | | $2,630.27 | $7,413.10 | $14,791.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $1,819.70 / $5,128.61
| Facility | | $724.44 | $1,819.70 | $5,128.61 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $794.33 / $794.33 / $794.33
| Facility | 54 | $794.33 | $794.33 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $4,168.69 / $9,549.93
| Facility | | $1,445.44 | $4,168.69 | $9,549.93 |