- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $860.00 / $2,562.00 / $5,432.00
| Facility | | $860.00 | $2,562.00 | $5,432.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $1,101.28 / $1,148.35 / $1,937.86
| Facility | 52 | $1,101.28 | $1,148.35 | $1,937.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,257.94 / $26,894.41 / $49,162.50
| Facility | | $14,257.94 | $26,894.41 | $49,162.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $40.00 / $1,517.44
| Facility | | $40.00 | $40.00 | $1,517.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $400.00 / $400.00 / $400.00
| Facility | | $400.00 | $400.00 | $400.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,200.00 / $6,034.00 / $13,506.00
| Facility | | $1,200.00 | $6,034.00 | $13,506.00 |