- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $269.15 / $2,630.27 / $7,943.28
| Facility | | $269.15 | $2,630.27 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $1,071.52 / $1,071.52 / $1,071.52
| Facility | 52 | $1,071.52 | $1,071.52 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.11 / $4,168.69 / $10,000.00
| Facility | | $1,479.11 | $4,168.69 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $245.47 / $1,023.29 / $6,309.57
| Facility | | $245.47 | $1,023.29 | $6,309.57 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $199.53 / $199.53 / $199.53
| Facility | 52 | $199.53 | $199.53 | $199.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $2,884.03 / $6,309.57
| Facility | | $1,023.29 | $2,884.03 | $6,309.57 |