- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $3,218.00 / $8,400.00
| Facility | | $1,000.00 | $3,218.00 | $8,400.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $155.72 / $155.72 / $155.72
| Facility | 52 | $155.72 | $155.72 | $155.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $277.95 / $420.43 / $4,083.73
| Facility | | $277.95 | $420.43 | $4,083.73 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $18,071.64 / $18,071.64 / $18,071.64
| Facility | 52 | $18,071.64 | $18,071.64 | $18,071.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.00 / $1,990.00 / $4,083.73
| Facility | | $575.00 | $1,990.00 | $4,083.73 |