- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $213.80 / $3,467.37 / $3,467.37
| Facility | | $213.80 | $3,467.37 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $229.09 / $229.09 / $275.42
| Facility | | $229.09 | $229.09 | $275.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $363.08 / $363.08
| Facility | | $34.67 | $363.08 | $363.08 |
- 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
- $6,606.93 / $6,606.93 / $29,512.09
| Facility | | $6,606.93 | $6,606.93 | $29,512.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $2,884.03 / $16,982.44
| Facility | | $2,884.03 | $2,884.03 | $16,982.44 |