- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $2,691.53 / $6,456.54
| Facility | | $1,122.02 | $2,691.53 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $3,235.94 / $4,677.35
| Facility | | $1,698.24 | $3,235.94 | $4,677.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,918.31 / $6,918.31 / $33,884.42
| Facility | | $6,918.31 | $6,918.31 | $33,884.42 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $4,786.30 / $4,786.30 / $4,786.30
| Facility | 54 | $4,786.30 | $4,786.30 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $3,630.78 / $6,309.57
| Facility | | $1,995.26 | $3,630.78 | $6,309.57 |