- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $303.16 / $2,350.51 / $5,389.00
| Facility | | $303.16 | $2,350.51 | $5,389.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $89.02 / $89.02 / $115.65
| Facility | 52 | $89.02 | $89.02 | $115.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $770.00 / $1,508.00 / $3,523.00
| Facility | | $770.00 | $1,508.00 | $3,523.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,213.00 / $2,769.00 / $4,641.00
| Facility | | $2,213.00 | $2,769.00 | $4,641.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $181.31 / $308.83 / $2,672.00
| Facility | | $181.31 | $308.83 | $2,672.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $396.26 / $3,716.72 / $3,716.72
| Facility | 52 | $396.26 | $3,716.72 | $3,716.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,021.42 / $2,261.00 / $2,963.00
| Facility | | $1,021.42 | $2,261.00 | $2,963.00 |