- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $395.21 / $2,954.00 / $6,562.74
| Facility | | $395.21 | $2,954.00 | $6,562.74 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $101.80 / $115.90 / $168.39
| Facility | 52 | $101.80 | $115.90 | $168.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.00 / $3,693.00 / $5,962.00
| Facility | | $1,905.00 | $3,693.00 | $5,962.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $455.00 / $861.35 / $1,675.01
| Facility | | $455.00 | $861.35 | $1,675.01 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $172.10 / $172.10 / $172.10
| Facility | 52 | $172.10 | $172.10 | $172.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $815.50 / $2,325.00 / $5,230.50
| Facility | | $815.50 | $2,325.00 | $5,230.50 |