- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,540.59 / $8,349.00 / $22,900.00
| Facility | | $1,540.59 | $8,349.00 | $22,900.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $770.30 / $770.30 / $921.50
| Facility | 52 | $770.30 | $770.30 | $921.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,500.00 / $10,500.00 / $10,500.00
| Facility | | $10,500.00 | $10,500.00 | $10,500.00 |
- 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 |