- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $724.44 / $1,412.54
| Facility | | $724.44 | $724.44 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $812.83 / $1,000.00
| Facility | | $812.83 | $812.83 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $1,288.25 / $1,862.09
| Facility | | $1,288.25 | $1,288.25 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $1,023.29 / $1,023.29 / $1,023.29
| Facility | 52 | $1,023.29 | $1,023.29 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $758.58 / $758.58
| Facility | | $758.58 | $758.58 | $758.58 |