- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $520.00 / $1,040.00 / $4,623.00
| Facility | | $520.00 | $1,040.00 | $4,623.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $370.43 / $370.43 / $1,084.83
| Facility | 52 | $370.43 | $370.43 | $1,084.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,276.80 / $20,276.80 / $20,276.80
| Facility | | $20,276.80 | $20,276.80 | $20,276.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,562.18 / $17,562.18 / $24,298.82
| Facility | | $17,562.18 | $17,562.18 | $24,298.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,390.00 / $10,208.00 / $19,044.00
| Facility | | $1,390.00 | $10,208.00 | $19,044.00 |