- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $394.04 / $2,747.00 / $7,205.00
| Facility | | $394.04 | $2,747.00 | $7,205.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $73.86 / $81.10 / $114.14
| Facility | 52 | $73.86 | $81.10 | $114.14 |
- 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
- $453.24 / $861.35 / $1,605.94
| Facility | | $453.24 | $861.35 | $1,605.94 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $125.57 / $125.57 / $125.57
| Facility | 52 | $125.57 | $125.57 | $125.57 |
- 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 |