- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,383.76 / $1,383.76 / $1,383.76
| Facility | | $1,383.76 | $1,383.76 | $1,383.76 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $691.88 / $691.88 / $691.88
| Facility | 52 | $691.88 | $691.88 | $691.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,504.14 / $11,339.86 / $22,633.97
| Facility | | $6,504.14 | $11,339.86 | $22,633.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,224.21 / $5,032.14 / $12,105.53
| Facility | | $3,224.21 | $5,032.14 | $12,105.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,794.06 / $4,592.17 / $9,531.91
| Facility | | $2,794.06 | $4,592.17 | $9,531.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,478.53 / $2,468.29 / $4,388.06
| Facility | | $1,478.53 | $2,468.29 | $4,388.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,960.00 / $7,872.00 / $11,531.00
| Facility | | $2,960.00 | $7,872.00 | $11,531.00 |