- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,862.00 / $7,521.00 / $9,637.10
| Facility | | $2,862.00 | $7,521.00 | $9,637.10 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $163.79 / $163.79 / $203.62
| Facility | 52 | $163.79 | $163.79 | $203.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,807.00 / $4,634.53 / $11,936.00
| Facility | | $2,807.00 | $4,634.53 | $11,936.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $998.00 / $6,605.47 / $10,800.33
| Facility | | $998.00 | $6,605.47 | $10,800.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,277.04 / $2,468.46 / $2,597.87
| Facility | | $1,277.04 | $2,468.46 | $2,597.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,048.00 / $7,771.00 / $11,371.00
| Facility | | $1,048.00 | $7,771.00 | $11,371.00 |