- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,318.31 / $5,463.36 / $13,841.56
| Facility | | $2,318.31 | $5,463.36 | $13,841.56 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $106.20 / $106.20 / $106.20
| Facility | 52 | $106.20 | $106.20 | $106.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,100.60 / $4,495.00 / $7,888.43
| Facility | | $3,100.60 | $4,495.00 | $7,888.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $212.39 / $374.34 / $1,407.74
| Facility | | $212.39 | $374.34 | $1,407.74 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $3,716.72 / $3,716.72 / $3,716.72
| Facility | 52 | $3,716.72 | $3,716.72 | $3,716.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $426.52 / $606.74 / $1,522.92
| Facility | | $426.52 | $606.74 | $1,522.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,044.00 / $3,726.00 / $7,934.00
| Facility | | $3,044.00 | $3,726.00 | $7,934.00 |