- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,733.20 / $7,365.00 / $13,523.00
| Facility | | $2,733.20 | $7,365.00 | $13,523.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $1,052.44 / $1,052.44 / $1,366.60
| Facility | 52 | $1,052.44 | $1,052.44 | $1,366.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,820.68 / $11,934.58 / $16,551.09
| Facility | | $2,820.68 | $11,934.58 | $16,551.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $624.00 / $624.00 / $624.00
| Facility | | $624.00 | $624.00 | $624.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,557.43 / $2,733.20 / $6,969.00
| Facility | | $1,557.43 | $2,733.20 | $6,969.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,798.00 / $6,969.00 / $14,082.00
| Facility | | $2,798.00 | $6,969.00 | $14,082.00 |