- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $863.05 / $2,736.07 / $6,483.00
| Facility | | $863.05 | $2,736.07 | $6,483.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $438.60 / $1,640.88 / $2,700.74
| Facility | | $438.60 | $1,640.88 | $2,700.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,459.33 / $1,459.33 / $1,459.33
| Facility | | $1,459.33 | $1,459.33 | $1,459.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $159.84 / $312.56 / $2,017.00
| Facility | | $159.84 | $312.56 | $2,017.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $524.38 / $524.38 / $524.38
| Facility | 52 | $524.38 | $524.38 | $524.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,566.00 / $2,567.00 / $5,029.00
| Facility | | $1,566.00 | $2,567.00 | $5,029.00 |