- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $249.36 / $2,331.21 / $3,800.61
| Facility | | $249.36 | $2,331.21 | $3,800.61 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $168.97 / $448.23 / $448.23
| Facility | 52 | $168.97 | $448.23 | $448.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,449.90 / $1,611.00 / $2,875.00
| Facility | | $1,449.90 | $1,611.00 | $2,875.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,751.69 / $1,751.69 / $1,812.99
| Facility | | $1,751.69 | $1,751.69 | $1,812.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $930.00 / $3,884.00 / $8,611.00
| Facility | | $930.00 | $3,884.00 | $8,611.00 |