- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $5,248.07 / $8,912.51
| Facility | | $2,041.74 | $5,248.07 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $3,311.31 / $4,897.79
| Facility | | $1,023.29 | $3,311.31 | $4,897.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.96 / $1,230.27 / $1,230.27
| Facility | | $870.96 | $1,230.27 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $1,778.28 / $5,128.61
| Facility | | $676.08 | $1,778.28 | $5,128.61 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $1,380.38 / $1,380.38 / $4,570.88
| Facility | 54 | $1,380.38 | $1,380.38 | $4,570.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $3,019.95 / $5,370.32
| Facility | | $1,949.84 | $3,019.95 | $5,370.32 |