- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,767.49 / $7,729.00 / $20,650.00
| Facility | | $1,767.49 | $7,729.00 | $20,650.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $883.75 / $883.75 / $1,016.47
| Facility | 52 | $883.75 | $883.75 | $1,016.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,449.00 / $14,449.00 / $15,090.00
| Facility | | $14,449.00 | $14,449.00 | $15,090.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28,306.58 / $31,281.82 / $67,834.27
| Facility | | $28,306.58 | $31,281.82 | $67,834.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,682.00 / $10,536.00 / $26,500.00
| Facility | | $5,682.00 | $10,536.00 | $26,500.00 |