- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $190.84 / $5,547.58 / $7,701.40
| Facility | | $190.84 | $5,547.58 | $7,701.40 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $95.42 / $95.42 / $148.28
| Facility | 52 | $95.42 | $95.42 | $148.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,234.00 / $5,117.00 / $8,240.00
| Facility | | $2,234.00 | $5,117.00 | $8,240.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $175.48 / $228.12 / $263.22
| Facility | | $175.48 | $228.12 | $263.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $219.76 / $761.00 / $1,158.10
| Facility | | $219.76 | $761.00 | $1,158.10 |
- 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
- $900.00 / $3,817.00 / $5,402.00
| Facility | | $900.00 | $3,817.00 | $5,402.00 |