- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $338.84 / $2,398.83 / $4,265.80
| Facility | | $338.84 | $2,398.83 | $4,265.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.99 / $2,089.30 / $2,951.21
| Facility | | $954.99 | $2,089.30 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $32.36 / $588.84 / $1,148.15
| Facility | | $32.36 | $588.84 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $26.30 / $26.30 / $26.30
| Facility | 52 | $26.30 | $26.30 | $26.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $54.95 / $2,884.03 / $2,884.03
| Facility | | $54.95 | $2,884.03 | $2,884.03 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $2,290.87 / $2,290.87 / $2,290.87
| Facility | 52 | $2,290.87 | $2,290.87 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $2,187.76 / $3,981.07
| Facility | | $1,000.00 | $2,187.76 | $3,981.07 |