- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,205.45 / $1,205.45 / $1,205.45
| Facility | | $1,205.45 | $1,205.45 | $1,205.45 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $602.73 / $602.73 / $602.73
| Facility | 52 | $602.73 | $602.73 | $602.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,178.08 / $3,144.69 / $10,060.10
| Facility | | $1,178.08 | $3,144.69 | $10,060.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,812.48 / $4,389.55 / $10,559.65
| Facility | | $2,812.48 | $4,389.55 | $10,559.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,437.26 / $4,005.75 / $8,314.69
| Facility | | $2,437.26 | $4,005.75 | $8,314.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,275.73 / $2,097.00 / $3,759.04
| Facility | | $1,275.73 | $2,097.00 | $3,759.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $796.00 / $3,500.00 / $8,152.00
| Facility | | $796.00 | $3,500.00 | $8,152.00 |