- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $2,187.76 / $5,495.41
| Facility | | $537.03 | $2,187.76 | $5,495.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $2,818.38 / $5,495.41
| Facility | | $1,659.59 | $2,818.38 | $5,495.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $123.03 / $151.36 / $208.93
| Facility | | $123.03 | $151.36 | $208.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $239.88 / $239.88 / $1,659.59
| Facility | | $239.88 | $239.88 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $190.55 / $190.55 / $190.55
| Facility | 52 | $190.55 | $190.55 | $190.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $1,348.96 / $5,248.07
| Facility | | $524.81 | $1,348.96 | $5,248.07 |