- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $250.35 / $716.55 / $1,831.00
| Facility | | $250.35 | $716.55 | $1,831.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $127.04 / $313.51 / $1,462.96
| Facility | 52 | $127.04 | $313.51 | $1,462.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,609.02 / $1,609.02 / $1,609.02
| Facility | | $1,609.02 | $1,609.02 | $1,609.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,665.90 / $1,665.90 / $1,665.90
| Facility | | $1,665.90 | $1,665.90 | $1,665.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $700.00 / $2,148.00 / $6,612.00
| Facility | | $700.00 | $2,148.00 | $6,612.00 |