- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,677.18 / $1,677.18 / $1,677.18
| Facility | | $1,677.18 | $1,677.18 | $1,677.18 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $838.59 / $838.59 / $838.59
| Facility | 52 | $838.59 | $838.59 | $838.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,466.88 / $11,802.73 / $23,333.99
| Facility | | $7,466.88 | $11,802.73 | $23,333.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,905.33 / $6,095.20 / $14,662.83
| Facility | | $3,905.33 | $6,095.20 | $14,662.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,384.31 / $5,562.27 / $11,545.54
| Facility | | $3,384.31 | $5,562.27 | $11,545.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,748.71 / $2,857.82 / $5,200.22
| Facility | | $1,748.71 | $2,857.82 | $5,200.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $796.00 / $2,260.00 / $5,379.86
| Facility | | $796.00 | $2,260.00 | $5,379.86 |