- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $612.00 / $1,850.00 / $3,945.00
| Facility | | $612.00 | $1,850.00 | $3,945.00 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $120.19 / $120.19 / $142.93
| Facility | 53 | $120.19 | $120.19 | $142.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,295.00 / $20,126.61 / $29,987.95
| Facility | | $10,295.00 | $20,126.61 | $29,987.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $40.00 / $40.00
| Facility | | $40.00 | $40.00 | $40.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,200.00 / $11,159.00 / $26,848.00
| Facility | | $1,200.00 | $11,159.00 | $26,848.00 |