- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.23 / $1,584.23 / $1,584.23
| Facility | | $1,584.23 | $1,584.23 | $1,584.23 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $792.12 / $792.12 / $792.12
| Facility | 52 | $792.12 | $792.12 | $792.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,392.28 / $3,144.69 / $13,270.43
| Facility | | $1,392.28 | $3,144.69 | $13,270.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,688.75 / $5,757.18 / $13,849.67
| Facility | | $3,688.75 | $5,757.18 | $13,849.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,196.62 / $5,253.80 / $10,905.25
| Facility | | $3,196.62 | $5,253.80 | $10,905.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,620.34 / $2,718.00 / $4,926.46
| Facility | | $1,620.34 | $2,718.00 | $4,926.46 |
- 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 |