- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $160.80 / $4,607.20 / $10,632.00
| Facility | | $160.80 | $4,607.20 | $10,632.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $120.00 / $1,393.45 / $2,213.00
| Facility | | $120.00 | $1,393.45 | $2,213.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $94.25 / $94.25 / $94.25
| Facility | 52 | $94.25 | $94.25 | $94.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,420.00 / $6,499.00 / $11,885.00
| Facility | | $3,420.00 | $6,499.00 | $11,885.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $573.00 / $3,514.00 / $7,044.00
| Facility | | $573.00 | $3,514.00 | $7,044.00 |