- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $250.35 / $865.20 / $2,902.75
| Facility | | $250.35 | $865.20 | $2,902.75 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $87.47 / $215.88 / $604.22
| Facility | 52 | $87.47 | $215.88 | $604.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,917.00 / $3,611.00 / $6,183.00
| Facility | | $1,917.00 | $3,611.00 | $6,183.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,463.77 / $1,500.80 / $16,394.00
| Facility | | $1,463.77 | $1,500.80 | $16,394.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $664.86 / $713.38 / $713.38
| Facility | 52 | $664.86 | $713.38 | $713.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,259.00 / $4,567.00 / $7,669.00
| Facility | | $2,259.00 | $4,567.00 | $7,669.00 |