- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,486.74 / $1,486.74 / $1,486.74
| Facility | | $1,486.74 | $1,486.74 | $1,486.74 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $743.37 / $743.37 / $743.37
| Facility | 52 | $743.37 | $743.37 | $743.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,005.69 / $11,603.59 / $22,633.97
| Facility | | $7,005.69 | $11,603.59 | $22,633.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,466.04 / $5,409.60 / $13,013.52
| Facility | | $3,466.04 | $5,409.60 | $13,013.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,003.63 / $4,936.60 / $10,246.86
| Facility | | $3,003.63 | $4,936.60 | $10,246.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,565.73 / $2,546.71 / $4,631.89
| Facility | | $1,565.73 | $2,546.71 | $4,631.89 |
- 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 |