- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $347.98 / $5,009.00 / $9,784.00
| Facility | | $347.98 | $5,009.00 | $9,784.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $163.11 / $163.11 / $242.47
| Facility | 52 | $163.11 | $163.11 | $242.47 |
- 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
- $13,095.98 / $14,472.48 / $14,472.48
| Facility | | $13,095.98 | $14,472.48 | $14,472.48 |
- 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 |