- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $7,244.36 / $16,595.87
| Facility | | $812.83 | $7,244.36 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.96 / $5,011.87 / $10,232.93
| Facility | | $870.96 | $5,011.87 | $10,232.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $537.03 / $5,370.32
| Facility | | $371.54 | $537.03 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $389.05 / $389.05 / $389.05
| Facility | 52 | $389.05 | $389.05 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $281.84 / $389.05 / $645.65
| Facility | | $281.84 | $389.05 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $6,309.57 / $10,471.29
| Facility | | $616.60 | $6,309.57 | $10,471.29 |