- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $3,981.07 / $7,762.47
| Facility | | $2,041.74 | $3,981.07 | $7,762.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $1,698.24 / $3,019.95
| Facility | | $630.96 | $1,698.24 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.13 / $4,786.30 / $7,762.47
| Facility | | $3,548.13 | $4,786.30 | $7,762.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $204.17 / $281.84 / $5,495.41
| Facility | | $204.17 | $281.84 | $5,495.41 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $436.52 / $18,197.01 / $18,197.01
| Facility | 52 | $436.52 | $18,197.01 | $18,197.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $4,365.16 / $7,244.36
| Facility | | $1,412.54 | $4,365.16 | $7,244.36 |