- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $584.11 / $2,341.64
| Facility | | $100.00 | $584.11 | $2,341.64 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $123.56 / $292.05 / $292.05
| Facility | 52 | $123.56 | $292.05 | $292.05 |
- 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 |