- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,040.00 / $1,900.00 / $3,038.18
| Facility | | $1,040.00 | $1,900.00 | $3,038.18 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $1,125.26 / $1,125.26 / $1,125.26
| Facility | 52 | $1,125.26 | $1,125.26 | $1,125.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,412.09 / $15,062.66 / $20,264.09
| Facility | | $12,412.09 | $15,062.66 | $20,264.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,219.00 / $11,284.00 / $11,735.00
| Facility | | $11,219.00 | $11,284.00 | $11,735.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,500.00 / $6,323.00 / $12,422.00
| Facility | | $1,500.00 | $6,323.00 | $12,422.00 |