- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $268.51 / $4,551.00 / $9,784.00
| Facility | | $268.51 | $4,551.00 | $9,784.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $134.26 / $134.26 / $219.71
| Facility | 52 | $134.26 | $134.26 | $219.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,438.00 / $3,438.00 / $3,438.00
| Facility | | $3,438.00 | $3,438.00 | $3,438.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,173.32 / $4,611.96 / $8,795.46
| Facility | | $4,173.32 | $4,611.96 | $8,795.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,204.00 / $5,225.00 / $10,536.00
| Facility | | $3,204.00 | $5,225.00 | $10,536.00 |