- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,485.15 / $1,485.15 / $1,485.15
| Facility | | $1,485.15 | $1,485.15 | $1,485.15 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $742.58 / $742.58 / $742.58
| Facility | 52 | $742.58 | $742.58 | $742.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,037.77 / $11,656.72 / $22,633.97
| Facility | | $7,037.77 | $11,656.72 | $22,633.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,454.56 / $5,391.68 / $12,970.41
| Facility | | $3,454.56 | $5,391.68 | $12,970.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,993.68 / $4,920.26 / $10,212.93
| Facility | | $2,993.68 | $4,920.26 | $10,212.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,564.22 / $2,566.80 / $4,607.17
| Facility | | $1,564.22 | $2,566.80 | $4,607.17 |
- 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 |