- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $5,495.41 / $13,182.57
| Facility | | $1,202.26 | $5,495.41 | $13,182.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,691.53 / $7,943.28 / $16,595.87
| Facility | | $2,691.53 | $7,943.28 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $2,290.87 / $6,760.83
| Facility | | $891.25 | $2,290.87 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $891.25 / $891.25 / $891.25
| Facility | 54 | $891.25 | $891.25 | $891.25 |
- 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 |