- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,251.00 / $2,600.00 / $10,742.62
| Facility | | $1,251.00 | $2,600.00 | $10,742.62 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $726.13 / $726.13 / $726.13
| Facility | 52 | $726.13 | $726.13 | $726.13 |
- Facility/Professional
- Facility
- Modifier
- 80
- Low / Median / High Price
- $3,729.80 / $3,729.80 / $3,729.80
| Facility | 80 | $3,729.80 | $3,729.80 | $3,729.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,591.87 / $5,572.46 / $7,496.74
| Facility | | $4,591.87 | $5,572.46 | $7,496.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,800.00 / $3,800.00 / $7,813.00
| Facility | | $3,800.00 | $3,800.00 | $7,813.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,125.00 / $5,085.00 / $9,624.00
| Facility | | $2,125.00 | $5,085.00 | $9,624.00 |