- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26.44 / $2,620.00 / $7,782.69
| Facility | | $26.44 | $2,620.00 | $7,782.69 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $10.28 / $12.17 / $16.33
| Facility | 52 | $10.28 | $12.17 | $16.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,651.00 / $3,263.00 / $4,636.00
| Facility | | $1,651.00 | $3,263.00 | $4,636.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $344.64 / $532.91 / $931.44
| Facility | | $344.64 | $532.91 | $931.44 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $16.70 / $16.70 / $16.70
| Facility | 52 | $16.70 | $16.70 | $16.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $815.50 / $2,335.00 / $5,253.50
| Facility | | $815.50 | $2,335.00 | $5,253.50 |