- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $2,089.30 / $5,623.41
| Facility | | $630.96 | $2,089.30 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $1,288.25 / $2,691.53
| Facility | | $549.54 | $1,288.25 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.68 / $891.25 / $1,584.89
| Facility | | $446.68 | $891.25 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $181.97 / $263.03 / $2,398.83
| Facility | | $181.97 | $263.03 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $398.11 / $3,715.35 / $3,715.35
| Facility | 52 | $398.11 | $3,715.35 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $1,862.09 / $4,677.35
| Facility | | $977.24 | $1,862.09 | $4,677.35 |