- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $296.33 / $1,181.00 / $3,109.00
| Facility | | $296.33 | $1,181.00 | $3,109.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $121.46 / $144.74 / $174.76
| Facility | 52 | $121.46 | $144.74 | $174.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,771.26 / $1,771.26 / $2,019.24
| Facility | | $1,771.26 | $1,771.26 | $2,019.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $490.00 / $515.00 / $930.22
| Facility | | $490.00 | $515.00 | $930.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $505.00 / $1,106.00 / $2,539.00
| Facility | | $505.00 | $1,106.00 | $2,539.00 |