- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.19 / $6,456.54 / $11,481.54
| Facility | | $380.19 | $6,456.54 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $3,890.45 / $8,317.64
| Facility | | $1,445.44 | $3,890.45 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $707.95 / $2,290.87
| Facility | | $436.52 | $707.95 | $2,290.87 |
- 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
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $380.19 / $407.38
| Professional | | $380.19 | $380.19 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $251.19 / $354.81 / $562.34
| Facility | | $251.19 | $354.81 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $10,232.93 / $16,982.44
| Facility | | $933.25 | $10,232.93 | $16,982.44 |