- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $900.00 / $2,694.00 / $5,604.00
| Facility | | $900.00 | $2,694.00 | $5,604.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $964.07 / $1,004.97 / $1,695.88
| Facility | 52 | $964.07 | $1,004.97 | $1,695.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,636.68 / $12,435.05 / $27,360.92
| Facility | | $5,636.68 | $12,435.05 | $27,360.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $40.00 / $1,335.84
| Facility | | $40.00 | $40.00 | $1,335.84 |
- 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
- $1,215.00 / $9,403.00 / $23,200.00
| Facility | | $1,215.00 | $9,403.00 | $23,200.00 |