- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $443.91 / $2,636.00 / $6,294.97
| Facility | | $443.91 | $2,636.00 | $6,294.97 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $171.95 / $176.22 / $196.21
| Facility | 52 | $171.95 | $176.22 | $196.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,565.49 / $4,278.33 / $6,461.26
| Facility | | $1,565.49 | $4,278.33 | $6,461.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $225.77 / $3,275.99 / $3,275.99
| Facility | | $225.77 | $3,275.99 | $3,275.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $290.89 / $901.00 / $1,932.08
| Facility | | $290.89 | $901.00 | $1,932.08 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $232.05 / $232.05 / $232.05
| Facility | 52 | $232.05 | $232.05 | $232.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $746.00 / $2,415.00 / $6,661.00
| Facility | | $746.00 | $2,415.00 | $6,661.00 |