- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $444.09 / $3,281.00 / $9,133.00
| Facility | | $444.09 | $3,281.00 | $9,133.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $86.45 / $119.10 / $222.05
| Facility | 52 | $86.45 | $119.10 | $222.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.10 / $1,374.46 / $1,697.86
| Facility | | $549.10 | $1,374.46 | $1,697.86 |
- 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
- $149.91 / $403.80 / $3,331.00
| Facility | | $149.91 | $403.80 | $3,331.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $825.00 / $2,081.00 / $3,918.00
| Facility | | $825.00 | $2,081.00 | $3,918.00 |