- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $403.86 / $1,250.00 / $1,831.00
| Facility | | $403.86 | $1,250.00 | $1,831.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $65.98 / $65.98 / $201.93
| Facility | 52 | $65.98 | $65.98 | $201.93 |
- 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 / $1,296.55
| Facility | | $550.00 | $782.14 | $1,296.55 |
- 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 |