- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,483.64 / $3,483.64 / $3,483.64
| Facility | | $3,483.64 | $3,483.64 | $3,483.64 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $108.37 / $108.37 / $163.98
| Facility | 52 | $108.37 | $108.37 | $163.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $228.23 / $253.99 / $276.72
| Facility | | $228.23 | $253.99 | $276.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $244.91 / $244.91 / $244.91
| Facility | | $244.91 | $244.91 | $244.91 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $191.49 / $191.49 / $191.49
| Facility | 52 | $191.49 | $191.49 | $191.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,645.71 / $2,645.71 / $2,645.71
| Facility | | $2,645.71 | $2,645.71 | $2,645.71 |