- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,975.21 / $4,933.00 / $4,933.00
| Facility | | $1,975.21 | $4,933.00 | $4,933.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $987.61 / $987.61 / $987.61
| Facility | 52 | $987.61 | $987.61 | $987.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,655.35 / $8,361.45 / $11,208.29
| Facility | | $5,655.35 | $8,361.45 | $11,208.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,606.38 / $4,933.00 / $4,933.00
| Facility | | $1,606.38 | $4,933.00 | $4,933.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $987.61 / $987.61 / $987.61
| Facility | 52 | $987.61 | $987.61 | $987.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,500.00 / $8,702.00 / $10,351.00
| Facility | | $3,500.00 | $8,702.00 | $10,351.00 |