- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,389.00 / $3,241.50 / $6,483.00
| Facility | | $1,389.00 | $3,241.50 | $6,483.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $224.46 / $856.56 / $1,367.66
| Facility | | $224.46 | $856.56 | $1,367.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,966.61 / $2,966.61 / $2,966.61
| Facility | | $2,966.61 | $2,966.61 | $2,966.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $251.38 / $1,286.58 / $3,638.00
| Facility | | $251.38 | $1,286.58 | $3,638.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $869.54 / $869.54 / $869.54
| Facility | 52 | $869.54 | $869.54 | $869.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,140.00 / $3,339.00 / $5,838.00
| Facility | | $2,140.00 | $3,339.00 | $5,838.00 |