- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $3,684.00 / $18,600.00
| Facility | | $1,000.00 | $3,684.00 | $18,600.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $456.70 / $456.70 / $456.70
| Facility | 52 | $456.70 | $456.70 | $456.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,858.92 / $9,241.20 / $14,654.94
| Facility | | $5,858.92 | $9,241.20 | $14,654.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $780.19 / $1,131.28 / $5,415.32
| Facility | | $780.19 | $1,131.28 | $5,415.32 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $3,102.73 / $3,102.73 / $3,102.73
| Facility | 52 | $3,102.73 | $3,102.73 | $3,102.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $580.00 / $2,545.00 / $6,155.68
| Facility | | $580.00 | $2,545.00 | $6,155.68 |