- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $2,331.21 / $6,067.00
| Facility | | $100.00 | $2,331.21 | $6,067.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $249.39 / $249.39 / $249.39
| Facility | 52 | $249.39 | $249.39 | $249.39 |
- 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
- $2,472.40 / $2,472.40 / $2,558.92
| Facility | | $2,472.40 | $2,472.40 | $2,558.92 |
- 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 |