- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $289.35 / $2,627.80 / $10,131.26
| Facility | | $289.35 | $2,627.80 | $10,131.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $830.24 / $4,458.42 / $9,143.61
| Facility | | $830.24 | $4,458.42 | $9,143.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $375.00 / $615.00 / $1,842.86
| Facility | | $375.00 | $615.00 | $1,842.86 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $94.25 / $94.25 / $94.25
| Facility | 52 | $94.25 | $94.25 | $94.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $108.01 / $141.36 / $214.24
| Facility | | $108.01 | $141.36 | $214.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $586.00 / $6,172.00 / $8,667.00
| Facility | | $586.00 | $6,172.00 | $8,667.00 |