- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $652.47 / $652.47 / $652.47
| Facility | | $652.47 | $652.47 | $652.47 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $130.49 / $130.49 / $130.49
| Facility | 53 | $130.49 | $130.49 | $130.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,428.23 / $15,768.49 / $33,458.26
| Facility | | $7,428.23 | $15,768.49 | $33,458.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,470.59 / $2,085.48 / $5,016.91
| Facility | | $1,470.59 | $2,085.48 | $5,016.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,195.49 / $1,906.63 / $3,950.33
| Facility | | $1,195.49 | $1,906.63 | $3,950.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,048.09 / $1,218.06 / $11,890.00
| Facility | | $1,048.09 | $1,218.06 | $11,890.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,577.00 / $10,743.00 / $12,774.00
| Facility | | $5,577.00 | $10,743.00 | $12,774.00 |