- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $213.80 / $2,041.74 / $7,413.10
| Facility | | $213.80 | $2,041.74 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $3,981.07 / $3,981.07 / $3,981.07
| Facility | 52 | $3,981.07 | $3,981.07 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $3,981.07 / $12,022.64
| Facility | | $1,445.44 | $3,981.07 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $107.15 / $3,090.30 / $9,772.37
| Facility | | $107.15 | $3,090.30 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $128.82 / $128.82 / $128.82
| Facility | 52 | $128.82 | $128.82 | $128.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.12 / $1,202.26 / $3,715.35
| Facility | | $295.12 | $1,202.26 | $3,715.35 |