- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $566.16 / $1,250.00 / $1,831.00
| Facility | | $566.16 | $1,250.00 | $1,831.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $134.74 / $134.74 / $412.38
| Facility | 52 | $134.74 | $134.74 | $412.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $339.15 / $339.15 / $373.07
| Facility | | $339.15 | $339.15 | $373.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.00 / $3,802.99 / $4,346.77
| Facility | | $588.00 | $3,802.99 | $4,346.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.00 / $1,305.00 / $4,939.00
| Facility | | $575.00 | $1,305.00 | $4,939.00 |