- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,508.50 / $7,655.00 / $14,100.00
| Facility | | $2,508.50 | $7,655.00 | $14,100.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $877.85 / $877.85 / $1,120.58
| Facility | 52 | $877.85 | $877.85 | $1,120.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,734.00 / $8,064.81 / $12,322.00
| Facility | | $2,734.00 | $8,064.81 | $12,322.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,463.08 / $2,779.57 / $10,616.00
| Facility | | $1,463.08 | $2,779.57 | $10,616.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,729.00 / $8,000.00 / $19,082.00
| Facility | | $2,729.00 | $8,000.00 | $19,082.00 |