- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $123.12 / $1,543.03 / $5,350.00
| Facility | | $123.12 | $1,543.03 | $5,350.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $35.54 / $56.39 / $90.13
| Facility | 52 | $35.54 | $56.39 | $90.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,615.00 / $4,120.00 / $7,588.00
| Facility | | $1,615.00 | $4,120.00 | $7,588.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $310.32 / $348.94 / $756.33
| Facility | | $310.32 | $348.94 | $756.33 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $90.26 / $90.26 / $90.26
| Facility | 52 | $90.26 | $90.26 | $90.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $437.00 / $1,138.00 / $2,720.00
| Facility | | $437.00 | $1,138.00 | $2,720.00 |