- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,153.54 / $2,666.00 / $6,986.00
| Facility | | $1,153.54 | $2,666.00 | $6,986.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $114.33 / $114.33 / $163.98
| Facility | 52 | $114.33 | $114.33 | $163.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,475.38 / $8,182.00 / $15,149.20
| Facility | | $2,475.38 | $8,182.00 | $15,149.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,438.00 / $3,438.00 / $3,438.00
| Facility | | $3,438.00 | $3,438.00 | $3,438.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,226.74 / $4,611.96 / $9,366.62
| Facility | | $4,226.74 | $4,611.96 | $9,366.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,204.00 / $5,225.00 / $10,536.00
| Facility | | $3,204.00 | $5,225.00 | $10,536.00 |