- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $199.53 / $199.53 / $5,011.87
| Facility | | $199.53 | $199.53 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $11,481.54 / $26,915.35
| Facility | | $1,318.26 | $11,481.54 | $26,915.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $478.63 / $776.25 / $1,819.70
| Facility | | $478.63 | $776.25 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $436.52 / $436.52 / $436.52
| Facility | 22 | $436.52 | $436.52 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $295.12 / $295.12 / $295.12
| Facility | 52 | $295.12 | $295.12 | $295.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $741.31 / $1,445.44
| Facility | | $588.84 | $741.31 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $213.80 / $407.38 / $5,495.41
| Facility | | $213.80 | $407.38 | $5,495.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $5,495.41 / $10,715.19
| Facility | | $1,445.44 | $5,495.41 | $10,715.19 |