- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $2,454.71 / $6,606.93
| Facility | | $912.01 | $2,454.71 | $6,606.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,244.36 / $11,481.54 / $18,620.87
| Facility | | $7,244.36 | $11,481.54 | $18,620.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $6,456.54 / $24,547.09
| Facility | | $912.01 | $6,456.54 | $24,547.09 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $72,443.60 / $72,443.60 / $72,443.60
| Facility | 52 | $72,443.60 | $72,443.60 | $72,443.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,495.41 / $16,218.10 / $25,703.96
| Facility | | $5,495.41 | $16,218.10 | $25,703.96 |