- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,105.00 / $3,073.00 / $9,691.00
| Facility | | $1,105.00 | $3,073.00 | $9,691.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $781.15 / $1,444.83 / $1,603.37
| Facility | 52 | $781.15 | $1,444.83 | $1,603.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,534.53 / $20,394.72 / $40,840.42
| Facility | | $9,534.53 | $20,394.72 | $40,840.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $875.00 / $908.00 / $16,000.00
| Facility | | $875.00 | $908.00 | $16,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,762.66 / $2,623.62 / $8,066.14
| Professional | | $1,762.66 | $2,623.62 | $8,066.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,421.00 / $8,100.00 / $21,651.00
| Facility | | $2,421.00 | $8,100.00 | $21,651.00 |