- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $2,331.21 / $9,859.00
| Facility | | $100.00 | $2,331.21 | $9,859.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $226.69 / $226.69 / $226.69
| Facility | 52 | $226.69 | $226.69 | $226.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,449.90 / $1,611.00 / $2,875.00
| Facility | | $1,449.90 | $1,611.00 | $2,875.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,862.32 / $2,862.32 / $2,962.50
| Facility | | $2,862.32 | $2,862.32 | $2,962.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $930.00 / $3,884.00 / $8,611.00
| Facility | | $930.00 | $3,884.00 | $8,611.00 |