- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $285.89 / $2,627.00 / $6,805.28
| Facility | | $285.89 | $2,627.00 | $6,805.28 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $78.03 / $121.23 / $192.97
| Facility | 52 | $78.03 | $121.23 | $192.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,759.00 / $3,693.00 / $5,962.00
| Facility | | $1,759.00 | $3,693.00 | $5,962.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $835.31 / $1,007.90 / $1,382.58
| Facility | | $835.31 | $1,007.90 | $1,382.58 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $198.16 / $198.16 / $198.16
| Facility | 52 | $198.16 | $198.16 | $198.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,495.00 / $2,643.50 / $5,500.00
| Facility | | $1,495.00 | $2,643.50 | $5,500.00 |