- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $194.98 / $3,630.78 / $8,912.51
| Facility | | $194.98 | $3,630.78 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $1,819.70 / $3,162.28 / $4,677.35
| Facility | 52 | $1,819.70 | $3,162.28 | $4,677.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $4,265.80 / $10,000.00
| Facility | | $1,621.81 | $4,265.80 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $181.97 / $630.96 / $2,187.76
| Facility | | $181.97 | $630.96 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $144.54 / $144.54 / $144.54
| Facility | 52 | $144.54 | $144.54 | $144.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $2,630.27 / $6,606.93
| Facility | | $645.65 | $2,630.27 | $6,606.93 |