- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,761.00 / $3,906.00 / $10,300.00
| Facility | | $1,761.00 | $3,906.00 | $10,300.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $780.83 / $780.83 / $858.05
| Facility | 52 | $780.83 | $780.83 | $858.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,347.00 / $17,472.00 / $19,025.00
| Facility | | $12,347.00 | $17,472.00 | $19,025.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,121.00 / $19,902.00 / $19,902.00
| Facility | | $16,121.00 | $19,902.00 | $19,902.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.60 / $1,766.79 / $10,785.81
| Professional | | $17.60 | $1,766.79 | $10,785.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,220.15 / $14,220.15 / $14,220.15
| Facility | | $14,220.15 | $14,220.15 | $14,220.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,042.00 / $4,794.00 / $26,000.00
| Facility | | $2,042.00 | $4,794.00 | $26,000.00 |