- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $242.02 / $1,552.00 / $4,069.00
| Facility | | $242.02 | $1,552.00 | $4,069.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $68.66 / $126.16 / $353.10
| Facility | 52 | $68.66 | $126.16 | $353.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,270.00 / $2,142.00 / $2,849.00
| Facility | | $1,270.00 | $2,142.00 | $2,849.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,154.30 / $1,184.54 / $12,000.00
| Facility | | $1,154.30 | $1,184.54 | $12,000.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $524.38 / $564.34 / $564.34
| Facility | 52 | $524.38 | $564.34 | $564.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.00 / $2,260.00 / $4,099.00
| Facility | | $1,122.00 | $2,260.00 | $4,099.00 |