- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,056.37 / $7,655.00 / $13,151.00
| Facility | | $3,056.37 | $7,655.00 | $13,151.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $1,160.40 / $1,160.40 / $1,528.19
| Facility | 52 | $1,160.40 | $1,160.40 | $1,528.19 |
- 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 / $2,240.56 / $3,555.71
| Facility | | $1,087.00 | $2,240.56 | $3,555.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $787.00 / $2,081.00 / $5,562.00
| Facility | | $787.00 | $2,081.00 | $5,562.00 |