- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,841.85 / $3,500.00 / $17,756.00
| Facility | | $1,841.85 | $3,500.00 | $17,756.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $5,653.10 / $5,653.10 / $5,653.10
| Facility | 52 | $5,653.10 | $5,653.10 | $5,653.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,091.00 / $15,727.00 / $25,437.00
| Facility | | $5,091.00 | $15,727.00 | $25,437.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,729.80 / $2,204.64 / $2,543.82
| Facility | | $1,729.80 | $2,204.64 | $2,543.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,699.00 / $10,000.00 / $15,750.00
| Facility | | $4,699.00 | $10,000.00 | $15,750.00 |