- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,904.22 / $7,655.00 / $13,151.00
| Facility | | $2,904.22 | $7,655.00 | $13,151.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $1,106.50 / $1,106.50 / $1,452.11
| Facility | 52 | $1,106.50 | $1,106.50 | $1,452.11 |
- 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 / $2,123.73 / $3,165.60
| Facility | | $1,087.00 | $2,123.73 | $3,165.60 |
- 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 |