- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $634.00 / $1,502.00 / $2,575.00
| Facility | | $634.00 | $1,502.00 | $2,575.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $122.05 / $122.05 / $373.55
| Facility | 52 | $122.05 | $122.05 | $373.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $308.10 / $308.10 / $338.91
| Facility | | $308.10 | $308.10 | $338.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $777.92 / $826.00 / $893.98
| Facility | | $777.92 | $826.00 | $893.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.00 / $1,305.00 / $4,939.00
| Facility | | $575.00 | $1,305.00 | $4,939.00 |