- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.26 / $4,470.00 / $12,154.00
| Facility | | $912.26 | $4,470.00 | $12,154.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $348.33 / $348.33 / $456.13
| Facility | 52 | $348.33 | $348.33 | $456.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,224.00 / $4,490.00 / $11,288.19
| Facility | | $2,224.00 | $4,490.00 | $11,288.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $731.48 / $1,358.47 / $11,500.00
| Facility | | $731.48 | $1,358.47 | $11,500.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $1,501.84 / $2,767.26 / $2,767.26
| Facility | 52 | $1,501.84 | $2,767.26 | $2,767.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,185.00 / $3,233.00 / $11,343.00
| Facility | | $1,185.00 | $3,233.00 | $11,343.00 |