- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $461.19 / $2,884.00 / $7,119.04
| Facility | | $461.19 | $2,884.00 | $7,119.04 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $120.58 / $140.93 / $194.36
| Facility | 52 | $120.58 | $140.93 | $194.36 |
- 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
- $470.49 / $861.35 / $1,758.30
| Facility | | $470.49 | $861.35 | $1,758.30 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $204.01 / $204.01 / $204.01
| Facility | 52 | $204.01 | $204.01 | $204.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $815.50 / $2,335.00 / $5,253.50
| Facility | | $815.50 | $2,335.00 | $5,253.50 |