- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,982.94 / $7,655.00 / $13,151.00
| Facility | | $2,982.94 | $7,655.00 | $13,151.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $1,136.25 / $1,136.25 / $1,491.47
| Facility | 52 | $1,136.25 | $1,136.25 | $1,491.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $914.00 / $914.00 / $914.00
| Facility | | $914.00 | $914.00 | $914.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,087.00 / $2,149.94 / $3,251.40
| Facility | | $1,087.00 | $2,149.94 | $3,251.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $783.00 / $1,743.00 / $5,562.00
| Facility | | $783.00 | $1,743.00 | $5,562.00 |