- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $935.94 / $935.94 / $935.94
| Facility | | $935.94 | $935.94 | $935.94 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $467.97 / $467.97 / $467.97
| Facility | 52 | $467.97 | $467.97 | $467.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,142.55 / $6,753.70 / $12,890.36
| Facility | | $4,142.55 | $6,753.70 | $12,890.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,181.11 / $3,404.14 / $8,189.12
| Facility | | $2,181.11 | $3,404.14 | $8,189.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,890.12 / $3,106.50 / $6,448.13
| Facility | | $1,890.12 | $3,106.50 | $6,448.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $883.44 / $1,615.71 / $2,972.74
| Facility | | $883.44 | $1,615.71 | $2,972.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $796.00 / $3,500.00 / $8,152.00
| Facility | | $796.00 | $3,500.00 | $8,152.00 |