- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $731.22 / $2,682.40 / $11,674.00
| Facility | | $731.22 | $2,682.40 | $11,674.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $154.28 / $365.61 / $365.61
| Facility | 52 | $154.28 | $365.61 | $365.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $603.00 / $1,000.00 / $3,729.17
| Facility | | $603.00 | $1,000.00 | $3,729.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $375.00 / $615.00 / $1,139.16
| Facility | | $375.00 | $615.00 | $1,139.16 |
- 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
- $268.52 / $368.48 / $541.47
| Facility | | $268.52 | $368.48 | $541.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $586.00 / $6,172.00 / $8,667.00
| Facility | | $586.00 | $6,172.00 | $8,667.00 |