- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $250.35 / $461.06 / $3,992.06
| Facility | | $250.35 | $461.06 | $3,992.06 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $96.50 / $230.53 / $507.59
| Facility | 52 | $96.50 | $230.53 | $507.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,609.02 / $1,609.02 / $1,609.02
| Facility | | $1,609.02 | $1,609.02 | $1,609.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,665.90 / $1,665.90 / $3,923.66
| Facility | | $1,665.90 | $1,665.90 | $3,923.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $860.00 / $2,717.00 / $7,175.00
| Facility | | $860.00 | $2,717.00 | $7,175.00 |