- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,174.83 / $7,365.00 / $13,151.00
| Facility | | $1,174.83 | $7,365.00 | $13,151.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $374.75 / $374.75 / $587.41
| Facility | 52 | $374.75 | $374.75 | $587.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,597.30 / $3,829.41 / $8,064.81
| Facility | | $2,597.30 | $3,829.41 | $8,064.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $624.58 / $1,478.01 / $19,381.88
| Facility | | $624.58 | $1,478.01 | $19,381.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,269.00 / $6,170.00 / $12,989.00
| Facility | | $2,269.00 | $6,170.00 | $12,989.00 |