- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.46 / $5,754.40 / $11,481.54
| Facility | | $1,905.46 | $5,754.40 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $3.80 / $3.80 / $3.80
| Facility | 52 | $3.80 | $3.80 | $3.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $758.58 / $1,659.59
| Facility | | $436.52 | $758.58 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $346.74 / $346.74 / $346.74
| Facility | 52 | $346.74 | $346.74 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,495.41 / $11,748.98 / $22,908.68
| Facility | | $5,495.41 | $11,748.98 | $22,908.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $5,623.41 / $9,549.93
| Facility | | $1,621.81 | $5,623.41 | $9,549.93 |