- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $3,890.45 / $6,760.83
| Facility | | $1,047.13 | $3,890.45 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.23 / $4,265.80 / $7,079.46
| Facility | | $2,754.23 | $4,265.80 | $7,079.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $213.80 / $346.74 / $6,165.95
| Facility | | $213.80 | $346.74 | $6,165.95 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $18,197.01 / $18,197.01 / $18,197.01
| Facility | 52 | $18,197.01 | $18,197.01 | $18,197.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $4,570.88 / $8,511.38
| Facility | | $1,230.27 | $4,570.88 | $8,511.38 |