- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,117.85 / $1,117.85 / $1,117.85
| Facility | | $1,117.85 | $1,117.85 | $1,117.85 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $558.92 / $558.92 / $558.92
| Facility | 52 | $558.92 | $558.92 | $558.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,178.08 / $3,144.69 / $9,307.91
| Facility | | $1,178.08 | $3,144.69 | $9,307.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,607.38 / $4,069.44 / $9,789.59
| Facility | | $2,607.38 | $4,069.44 | $9,789.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,259.52 / $3,713.63 / $7,708.34
| Facility | | $2,259.52 | $3,713.63 | $7,708.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,180.25 / $2,041.05 / $3,500.00
| Facility | | $1,180.25 | $2,041.05 | $3,500.00 |
- 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 |