- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $4,677.35 / $6,456.54
| Facility | | $1,621.81 | $4,677.35 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,265.80 / $6,456.54 / $14,791.08
| Facility | | $4,265.80 | $6,456.54 | $14,791.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $954.99 / $2,238.72
| Facility | | $588.84 | $954.99 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $346.74 / $346.74 / $346.74
| Facility | 52 | $346.74 | $346.74 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $1,071.52 / $1,778.28
| Facility | | $724.44 | $1,071.52 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $269.15 / $588.84 / $4,570.88
| Facility | | $269.15 | $588.84 | $4,570.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $4,786.30 / $8,912.51
| Facility | | $1,659.59 | $4,786.30 | $8,912.51 |