- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,070.00 / $4,919.00 / $12,600.00
| Facility | | $2,070.00 | $4,919.00 | $12,600.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $634.27 / $634.27 / $809.82
| Facility | 52 | $634.27 | $634.27 | $809.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,573.00 / $6,573.00 / $6,573.00
| Facility | | $6,573.00 | $6,573.00 | $6,573.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,057.11 / $1,611.84 / $26,542.00
| Facility | | $1,057.11 | $1,611.84 | $26,542.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,081.00 / $7,665.00 / $27,459.00
| Facility | | $3,081.00 | $7,665.00 | $27,459.00 |