- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,730.70 / $2,868.13 / $6,714.30
| Facility | | $2,730.70 | $2,868.13 | $6,714.30 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $32.71 / $32.71 / $57.40
| Facility | 52 | $32.71 | $32.71 | $57.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $70.36 / $77.92 / $84.89
| Facility | | $70.36 | $77.92 | $84.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $112.83 / $112.83 / $112.83
| Facility | | $112.83 | $112.83 | $112.83 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $90.26 / $90.26 / $90.26
| Facility | 52 | $90.26 | $90.26 | $90.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $261.67 / $2,028.50 / $5,873.81
| Facility | | $261.67 | $2,028.50 | $5,873.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $460.00 / $460.00 / $460.00
| Facility | | $460.00 | $460.00 | $460.00 |