- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $740.00 / $1,502.00 / $2,214.81
| Facility | | $740.00 | $1,502.00 | $2,214.81 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $404.17 / $404.17 / $1,107.41
| Facility | 52 | $404.17 | $404.17 | $1,107.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,621.02 / $20,621.02 / $20,621.02
| Facility | | $20,621.02 | $20,621.02 | $20,621.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,542.11 / $17,542.11 / $24,298.82
| Facility | | $17,542.11 | $17,542.11 | $24,298.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,390.00 / $9,987.00 / $17,543.00
| Facility | | $1,390.00 | $9,987.00 | $17,543.00 |