- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,131.00 / $7,655.00 / $16,400.00
| Facility | | $3,131.00 | $7,655.00 | $16,400.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $1,151.65 / $1,151.65 / $1,492.54
| Facility | 52 | $1,151.65 | $1,151.65 | $1,492.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,477.32 / $15,672.94 / $41,423.86
| Facility | | $13,477.32 | $15,672.94 | $41,423.86 |
- 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
- $1,660.43 / $2,889.97 / $10,268.00
| Facility | | $1,660.43 | $2,889.97 | $10,268.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,894.00 / $10,300.00 / $24,722.00
| Facility | | $2,894.00 | $10,300.00 | $24,722.00 |