- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.96 / $4,073.80 / $9,332.54
| Facility | | $870.96 | $4,073.80 | $9,332.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $912.01 / $4,677.35
| Facility | | $323.59 | $912.01 | $4,677.35 |
- 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
- $5,495.41 / $11,748.98 / $22,908.68
| Facility | | $5,495.41 | $11,748.98 | $22,908.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $3,548.13 / $6,918.31
| Facility | | $707.95 | $3,548.13 | $6,918.31 |