- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $275.12 / $3,992.69 / $4,933.00
| Facility | | $275.12 | $3,992.69 | $4,933.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $137.56 / $137.56 / $137.56
| Facility | 52 | $137.56 | $137.56 | $137.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,367.99 / $6,458.09 / $8,916.03
| Facility | | $4,367.99 | $6,458.09 | $8,916.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $239.81 / $4,112.00 / $5,756.00
| Facility | | $239.81 | $4,112.00 | $5,756.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $137.56 / $137.56 / $137.56
| Facility | 52 | $137.56 | $137.56 | $137.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,500.00 / $7,780.00 / $8,911.00
| Facility | | $2,500.00 | $7,780.00 | $8,911.00 |