- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,681.90 / $2,678.00 / $7,602.00
| Facility | | $1,681.90 | $2,678.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $356.34 / $492.58 / $1,012.76
| Facility | 52 | $356.34 | $492.58 | $1,012.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,417.00 / $2,344.00 / $4,147.00
| Facility | | $1,417.00 | $2,344.00 | $4,147.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,642.88 / $6,844.48 / $11,500.00
| Facility | | $5,642.88 | $6,844.48 | $11,500.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $1,501.84 / $2,944.24 / $2,944.24
| Facility | 52 | $1,501.84 | $2,944.24 | $2,944.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,200.00 / $2,665.00 / $4,918.00
| Facility | | $1,200.00 | $2,665.00 | $4,918.00 |