- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $899.47 / $3,392.50 / $8,074.63
| Facility | | $899.47 | $3,392.50 | $8,074.63 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $382.96 / $418.51 / $583.53
| Facility | 52 | $382.96 | $418.51 | $583.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,195.00 / $10,269.77 / $19,699.32
| Facility | | $5,195.00 | $10,269.77 | $19,699.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $875.00 / $875.00 / $1,194.08
| Facility | | $875.00 | $875.00 | $1,194.08 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $677.34 / $677.34 / $677.34
| Facility | 52 | $677.34 | $677.34 | $677.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,403.00 / $3,325.00 / $8,198.00
| Facility | | $1,403.00 | $3,325.00 | $8,198.00 |