- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $95.50 / $2,630.27 / $4,677.35
| Facility | | $95.50 | $2,630.27 | $4,677.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $5,248.07 / $12,589.25
| Facility | | $645.65 | $5,248.07 | $12,589.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $234.42 / $371.54 / $891.25
| Facility | | $234.42 | $371.54 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $144.54 / $144.54 / $144.54
| Facility | 52 | $144.54 | $144.54 | $144.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $288.40 / $363.08 / $707.95
| Facility | | $288.40 | $363.08 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $102.33 / $177.83 / $2,290.87
| Facility | | $102.33 | $177.83 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $2,691.53 / $7,079.46
| Facility | | $1,000.00 | $2,691.53 | $7,079.46 |