- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $141.10 / $214.54 / $1,600.00
| Facility | | $141.10 | $214.54 | $1,600.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $70.55 / $70.55 / $107.27
| Facility | 52 | $70.55 | $70.55 | $107.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $149.51 / $166.14 / $181.02
| Facility | | $149.51 | $166.14 | $181.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $160.19 / $160.19 / $160.19
| Facility | | $160.19 | $160.19 | $160.19 |
- 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
- $3,094.09 / $3,094.09 / $7,919.05
| Facility | | $3,094.09 | $3,094.09 | $7,919.05 |