- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,700.00 / $7,655.00 / $13,151.00
| Facility | | $1,700.00 | $7,655.00 | $13,151.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $779.24 / $779.24 / $1,023.34
| Facility | 52 | $779.24 | $779.24 | $1,023.34 |
- 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
- $1,086.24 / $1,520.32 / $2,620.15
| Facility | | $1,086.24 | $1,520.32 | $2,620.15 |
- 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 |