- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $618.00 / $1,968.00 / $5,234.00
| Facility | | $618.00 | $1,968.00 | $5,234.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $552.79 / $2,055.03 / $3,616.69
| Facility | | $552.79 | $2,055.03 | $3,616.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.00 / $971.62 / $1,591.99
| Facility | | $446.00 | $971.62 | $1,591.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $183.53 / $251.11 / $1,900.00
| Facility | | $183.53 | $251.11 | $1,900.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $396.26 / $3,716.72 / $3,716.72
| Facility | 52 | $396.26 | $3,716.72 | $3,716.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $966.00 / $2,517.00 / $4,486.00
| Facility | | $966.00 | $2,517.00 | $4,486.00 |