- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,019.71 / $9,842.00 / $21,953.00
| Facility | | $2,019.71 | $9,842.00 | $21,953.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $1,009.86 / $1,009.86 / $1,197.66
| Facility | 52 | $1,009.86 | $1,009.86 | $1,197.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,500.00 / $15,754.00 / $16,453.00
| Facility | | $10,500.00 | $15,754.00 | $16,453.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,571.00 / $9,571.00 / $9,571.00
| Facility | | $9,571.00 | $9,571.00 | $9,571.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,066.00 / $15,296.00 / $27,214.00
| Facility | | $6,066.00 | $15,296.00 | $27,214.00 |