- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $502.39 / $3,636.01 / $7,541.77
| Facility | | $502.39 | $3,636.01 | $7,541.77 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $113.45 / $123.40 / $175.67
| Facility | 52 | $113.45 | $123.40 | $175.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,807.00 / $5,299.00 / $10,705.00
| Facility | | $2,807.00 | $5,299.00 | $10,705.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $500.00 / $1,765.00 / $6,644.00
| Facility | | $500.00 | $1,765.00 | $6,644.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $191.49 / $191.49 / $191.49
| Facility | 52 | $191.49 | $191.49 | $191.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,428.50 / $4,276.00 / $8,976.50
| Facility | | $1,428.50 | $4,276.00 | $8,976.50 |