- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.48 / $1,819.48 / $1,819.48
| Facility | | $1,819.48 | $1,819.48 | $1,819.48 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $363.90 / $363.90 / $363.90
| Facility | 53 | $363.90 | $363.90 | $363.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,398.12 / $18,757.52 / $39,554.44
| Facility | | $8,398.12 | $18,757.52 | $39,554.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,041.18 / $5,730.90 / $13,786.45
| Facility | | $4,041.18 | $5,730.90 | $13,786.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,285.19 / $5,239.42 / $10,855.48
| Facility | | $3,285.19 | $5,239.42 | $10,855.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,257.88 / $3,347.89 / $4,982.91
| Facility | | $2,257.88 | $3,347.89 | $4,982.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,751.00 / $3,500.00 / $8,152.00
| Facility | | $1,751.00 | $3,500.00 | $8,152.00 |