- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $3,145.00 / $8,400.00
| Facility | | $1,000.00 | $3,145.00 | $8,400.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,733.72 / $5,839.76 / $9,111.19
| Facility | | $3,733.72 | $5,839.76 | $9,111.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $107.32 / $155.38 / $4,012.00
| Facility | | $107.32 | $155.38 | $4,012.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $6,012.68 / $6,012.68 / $6,012.68
| Facility | 52 | $6,012.68 | $6,012.68 | $6,012.68 |
- 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 |