- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $123.03 / $2,951.21 / $6,456.54
| Facility | | $123.03 | $2,951.21 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $1,819.70 / $4,168.69
| Facility | | $676.08 | $1,819.70 | $4,168.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.76 / $2,187.76 / $2,187.76
| Facility | | $2,187.76 | $2,187.76 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $97.72 / $162.18 / $3,090.30
| Facility | | $97.72 | $162.18 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $213.80 / $6,025.60 / $6,025.60
| Facility | 52 | $213.80 | $6,025.60 | $6,025.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,698.24 / $3,019.95
| Facility | | $1,071.52 | $1,698.24 | $3,019.95 |