- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,532.34 / $7,016.00 / $14,100.00
| Facility | | $2,532.34 | $7,016.00 | $14,100.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $974.77 / $974.77 / $1,266.17
| Facility | 52 | $974.77 | $974.77 | $1,266.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,352.22 / $9,955.54 / $19,495.91
| Facility | | $5,352.22 | $9,955.54 | $19,495.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $624.00 / $624.00 / $624.00
| Facility | | $624.00 | $624.00 | $624.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,624.61 / $2,608.65 / $24,722.00
| Facility | | $1,624.61 | $2,608.65 | $24,722.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,972.00 / $5,032.00 / $25,734.00
| Facility | | $1,972.00 | $5,032.00 | $25,734.00 |