- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $3,548.13 / $8,709.64
| Facility | | $588.84 | $3,548.13 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $4,897.79 / $10,471.29
| Facility | | $1,621.81 | $4,897.79 | $10,471.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $239.88 / $707.95 / $1,659.59
| Facility | | $239.88 | $707.95 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $190.55 / $190.55 / $190.55
| Facility | 52 | $190.55 | $190.55 | $190.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $2,630.27 / $6,309.57
| Facility | | $660.69 | $2,630.27 | $6,309.57 |