- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $762.00 / $1,850.00 / $3,945.00
| Facility | | $762.00 | $1,850.00 | $3,945.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $584.77 / $584.77 / $614.57
| Facility | 52 | $584.77 | $584.77 | $614.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,163.79 / $22,915.43 / $41,441.16
| Facility | | $13,163.79 | $22,915.43 | $41,441.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $40.00 / $40.00
| Facility | | $40.00 | $40.00 | $40.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,200.00 / $11,159.00 / $24,651.00
| Facility | | $1,200.00 | $11,159.00 | $24,651.00 |