- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $900.00 / $2,779.16 / $5,604.00
| Facility | | $900.00 | $2,779.16 | $5,604.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $1,108.16 / $1,154.98 / $1,949.03
| Facility | 52 | $1,108.16 | $1,154.98 | $1,949.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,227.43 / $9,462.25 / $14,166.86
| Facility | | $5,227.43 | $9,462.25 | $14,166.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,289.43 / $1,289.43 / $1,289.43
| Facility | | $1,289.43 | $1,289.43 | $1,289.43 |
- 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
- $1,449.00 / $10,045.00 / $34,611.00
| Facility | | $1,449.00 | $10,045.00 | $34,611.00 |