- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,440.84 / $4,933.00 / $5,757.00
| Facility | | $2,440.84 | $4,933.00 | $5,757.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $1,220.42 / $1,220.42 / $1,267.35
| Facility | 52 | $1,220.42 | $1,220.42 | $1,267.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,780.14 / $17,347.54 / $23,503.15
| Facility | | $14,780.14 | $17,347.54 | $23,503.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,006.05 / $4,933.00 / $5,757.00
| Facility | | $2,006.05 | $4,933.00 | $5,757.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $1,220.42 / $1,220.42 / $1,220.42
| Facility | 52 | $1,220.42 | $1,220.42 | $1,220.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,356.00 / $11,464.00 / $17,095.00
| Facility | | $5,356.00 | $11,464.00 | $17,095.00 |