- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $190.55 / $2,570.40 / $5,888.44
| Facility | | $190.55 | $2,570.40 | $5,888.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $7,079.46 / $16,982.44
| Facility | | $1,122.02 | $7,079.46 | $16,982.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $1,698.24 / $4,073.80
| Facility | | $1,202.26 | $1,698.24 | $4,073.80 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $251.19 / $251.19 / $251.19
| Facility | 52 | $251.19 | $251.19 | $251.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $1,621.81 / $3,162.28
| Facility | | $1,318.26 | $1,621.81 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.12 / $1,122.02 / $6,165.95
| Facility | | $295.12 | $1,122.02 | $6,165.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $6,025.60 / $10,715.19
| Facility | | $1,584.89 | $6,025.60 | $10,715.19 |