- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $3,715.35 / $9,549.93
| Facility | | $724.44 | $3,715.35 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $4,786.30 / $13,803.84
| Facility | | $1,584.89 | $4,786.30 | $13,803.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $426.58 / $812.83 / $6,025.60
| Facility | | $426.58 | $812.83 | $6,025.60 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $389.05 / $389.05 / $389.05
| Facility | 52 | $389.05 | $389.05 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $2,884.03 / $7,244.36
| Facility | | $660.69 | $2,884.03 | $7,244.36 |