- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $354.81 / $4,265.80 / $7,762.47
| Facility | | $354.81 | $4,265.80 | $7,762.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,890.45 / $6,165.95 / $9,772.37
| Facility | | $3,890.45 | $6,165.95 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $251.19 / $380.19 / $5,888.44
| Facility | | $251.19 | $380.19 | $5,888.44 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $6,025.60 / $6,025.60 / $6,025.60
| Facility | 52 | $6,025.60 | $6,025.60 | $6,025.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $3,311.31 / $6,025.60
| Facility | | $891.25 | $3,311.31 | $6,025.60 |