- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $619.27 / $1,502.00 / $2,575.00
| Facility | | $619.27 | $1,502.00 | $2,575.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $101.17 / $101.17 / $309.64
| Facility | 52 | $101.17 | $101.17 | $309.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $254.71 / $254.71 / $280.18
| Facility | | $254.71 | $254.71 | $280.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,121.00 / $3,812.28 / $4,357.39
| Facility | | $1,121.00 | $3,812.28 | $4,357.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $860.00 / $2,717.00 / $8,411.00
| Facility | | $860.00 | $2,717.00 | $8,411.00 |