- 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
- $10.56 / $10.56 / $10.56
| Facility | 52 | $10.56 | $10.56 | $10.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $365.06 / $490.27 / $710.17
| Facility | | $365.06 | $490.27 | $710.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20.14 / $34.36 / $2,951.70
| Facility | | $20.14 | $34.36 | $2,951.70 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $2,165.08 / $2,165.08 / $2,165.08
| Facility | 52 | $2,165.08 | $2,165.08 | $2,165.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.00 / $1,928.00 / $4,012.00
| Facility | | $575.00 | $1,928.00 | $4,012.00 |