- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $375.84 / $5,071.03
| Facility | | $100.00 | $375.84 | $5,071.03 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $187.92 / $187.92 / $187.92
| Facility | 52 | $187.92 | $187.92 | $187.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,769.10 / $5,299.00 / $8,600.00
| Facility | | $4,769.10 | $5,299.00 | $8,600.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,257.46 / $5,257.46 / $5,441.47
| Facility | | $5,257.46 | $5,257.46 | $5,441.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $854.00 / $4,487.00 / $9,949.00
| Facility | | $854.00 | $4,487.00 | $9,949.00 |