- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $339.60 / $4,247.00 / $7,023.00
| Facility | | $339.60 | $4,247.00 | $7,023.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $169.80 / $169.80 / $169.80
| Facility | 52 | $169.80 | $169.80 | $169.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,247.00 / $4,247.00 / $4,247.00
| Facility | | $4,247.00 | $4,247.00 | $4,247.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,525.68 / $6,104.56 / $8,896.10
| Facility | | $4,525.68 | $6,104.56 | $8,896.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,981.00 / $4,247.00 / $6,959.00
| Facility | | $1,981.00 | $4,247.00 | $6,959.00 |