- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,386.00 / $2,877.80 / $10,985.00
| Facility | | $1,386.00 | $2,877.80 | $10,985.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $876.87 / $876.87 / $2,253.56
| Facility | 52 | $876.87 | $876.87 | $2,253.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,499.00 / $35,179.00 / $49,433.26
| Facility | | $12,499.00 | $35,179.00 | $49,433.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,736.90 / $2,383.98 / $3,575.97
| Facility | | $1,736.90 | $2,383.98 | $3,575.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,526.00 / $15,288.00 / $26,923.00
| Facility | | $6,526.00 | $15,288.00 | $26,923.00 |