- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $465.51 / $1,520.00 / $3,685.00
| Facility | | $465.51 | $1,520.00 | $3,685.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $201.89 / $209.04 / $232.76
| Facility | 52 | $201.89 | $209.04 | $232.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,594.65 / $6,383.00 / $10,991.61
| Facility | | $3,594.65 | $6,383.00 | $10,991.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $249.32 / $7,035.74 / $7,035.74
| Facility | | $249.32 | $7,035.74 | $7,035.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $325.48 / $525.00 / $5,821.71
| Facility | | $325.48 | $525.00 | $5,821.71 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $254.41 / $254.41 / $254.41
| Facility | 52 | $254.41 | $254.41 | $254.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $464.00 / $1,429.00 / $4,010.00
| Facility | | $464.00 | $1,429.00 | $4,010.00 |