- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $798.32 / $2,588.50 / $8,604.00
| Facility | | $798.32 | $2,588.50 | $8,604.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $109.78 / $151.27 / $367.87
| Facility | 52 | $109.78 | $151.27 | $367.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $578.00 / $1,699.50 / $2,082.62
| Facility | | $578.00 | $1,699.50 | $2,082.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,690.00 / $9,690.00 / $9,690.00
| Facility | | $9,690.00 | $9,690.00 | $9,690.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $190.35 / $735.73 / $6,307.00
| Facility | | $190.35 | $735.73 | $6,307.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,779.00 / $3,647.00 / $6,988.00
| Facility | | $1,779.00 | $3,647.00 | $6,988.00 |