- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $143.66 / $1,885.01 / $7,212.00
| Facility | | $143.66 | $1,885.01 | $7,212.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $71.84 / $134.22 / $175.83
| Facility | 52 | $71.84 | $134.22 | $175.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,682.00 / $3,840.00 / $7,747.00
| Facility | | $1,682.00 | $3,840.00 | $7,747.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $132.44 / $172.17 / $205.28
| Facility | | $132.44 | $172.17 | $205.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,061.59 / $1,061.59 / $1,061.59
| Facility | | $1,061.59 | $1,061.59 | $1,061.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,400.00 / $3,870.00 / $5,490.00
| Facility | | $2,400.00 | $3,870.00 | $5,490.00 |