- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $649.60 / $3,424.50 / $7,897.50
| Facility | | $649.60 | $3,424.50 | $7,897.50 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $134.26 / $146.61 / $211.75
| Facility | 52 | $134.26 | $146.61 | $211.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.00 / $3,931.00 / $8,217.00
| Facility | | $1,905.00 | $3,931.00 | $8,217.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $506.00 / $870.49 / $1,758.30
| Facility | | $506.00 | $870.49 | $1,758.30 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $230.55 / $230.55 / $230.55
| Facility | 52 | $230.55 | $230.55 | $230.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $815.50 / $2,325.00 / $5,253.50
| Facility | | $815.50 | $2,325.00 | $5,253.50 |