- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $3,715.35 / $7,943.28
| Facility | | $1,737.80 | $3,715.35 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $245.47 / $645.65 / $1,174.90
| Facility | | $245.47 | $645.65 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $426.58 / $512.86 / $933.25
| Facility | | $426.58 | $512.86 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18.20 / $28.18 / $2,398.83
| Facility | | $18.20 | $28.18 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $38.90 / $2,187.76 / $2,187.76
| Facility | 52 | $38.90 | $2,187.76 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $1,698.24 / $4,677.35
| Facility | | $794.33 | $1,698.24 | $4,677.35 |