- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,671.00 / $3,617.00 / $6,329.00
| Facility | | $1,671.00 | $3,617.00 | $6,329.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,763.75 / $6,598.50 / $10,860.55
| Facility | | $1,763.75 | $6,598.50 | $10,860.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $719.23 / $1,006.92 / $4,337.00
| Facility | | $719.23 | $1,006.92 | $4,337.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $1,501.84 / $2,767.26 / $2,767.26
| Facility | 52 | $1,501.84 | $2,767.26 | $2,767.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,424.00 / $3,269.00 / $14,572.00
| Facility | | $1,424.00 | $3,269.00 | $14,572.00 |