- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $77.62 / $575.44 / $3,890.45
| Facility | | $77.62 | $575.44 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,778.28 / $1,905.46 / $3,801.89
| Facility | | $1,778.28 | $1,905.46 | $3,801.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $51.29 / $63.10 / $83.18
| Facility | | $51.29 | $63.10 | $83.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $123.03 / $123.03 / $151.36
| Facility | | $123.03 | $123.03 | $151.36 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $24.55 / $24.55 / $24.55
| Facility | 53 | $24.55 | $24.55 | $24.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.13 / $794.33 / $3,388.44
| Facility | | $331.13 | $794.33 | $3,388.44 |