- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $452.82 / $1,250.00 / $2,010.00
| Facility | | $452.82 | $1,250.00 | $2,010.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $107.76 / $107.76 / $329.82
| Facility | 52 | $107.76 | $107.76 | $329.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $861.98 / $861.98 / $861.98
| Facility | | $861.98 | $861.98 | $861.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $550.00 / $782.14 / $1,851.73
| Facility | | $550.00 | $782.14 | $1,851.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.00 / $1,305.00 / $3,191.00
| Facility | | $575.00 | $1,305.00 | $3,191.00 |