- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $91.20 / $1,778.28 / $6,456.54
| Facility | | $91.20 | $1,778.28 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $2,630.27 / $4,168.69
| Facility | | $1,698.24 | $2,630.27 | $4,168.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $58.88 / $162.18 / $1,288.25
| Facility | | $58.88 | $162.18 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $51.29 / $51.29 / $51.29
| Facility | 53 | $51.29 | $51.29 | $51.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $1,348.96 / $2,630.27
| Facility | | $371.54 | $1,348.96 | $2,630.27 |