- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,056.48 / $2,884.00 / $7,684.00
| Facility | | $1,056.48 | $2,884.00 | $7,684.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $140.93 / $140.93 / $194.66
| Facility | 52 | $140.93 | $140.93 | $194.66 |
- 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
- $3,844.73 / $4,611.96 / $10,000.99
| Facility | | $3,844.73 | $4,611.96 | $10,000.99 |
- 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 |