- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $900.00 / $3,060.00 / $13,686.00
| Facility | | $900.00 | $3,060.00 | $13,686.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $984.67 / $984.67 / $1,036.88
| Facility | 52 | $984.67 | $984.67 | $1,036.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,663.12 / $8,790.86 / $19,838.95
| Facility | | $2,663.12 | $8,790.86 | $19,838.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,155.62 / $8,155.62 / $8,155.62
| Facility | | $8,155.62 | $8,155.62 | $8,155.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,215.00 / $8,932.00 / $19,270.00
| Facility | | $1,215.00 | $8,932.00 | $19,270.00 |