- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $138.22 / $1,100.00 / $3,500.00
| Facility | | $138.22 | $1,100.00 | $3,500.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $39.64 / $60.85 / $103.84
| Facility | 52 | $39.64 | $60.85 | $103.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $242.26 / $547.76 / $756.50
| Facility | | $242.26 | $547.76 | $756.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $40.00 / $40.00
| Facility | | $40.00 | $40.00 | $40.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $210.00 / $580.00 / $1,506.00
| Facility | | $210.00 | $580.00 | $1,506.00 |