- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,386.00 / $2,318.00 / $10,985.00
| Facility | | $1,386.00 | $2,318.00 | $10,985.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $701.66 / $701.66 / $1,153.33
| Facility | 52 | $701.66 | $701.66 | $1,153.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,168.00 / $35,293.60 / $50,348.10
| Facility | | $14,168.00 | $35,293.60 | $50,348.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,392.19 / $1,910.85 / $2,866.28
| Facility | | $1,392.19 | $1,910.85 | $2,866.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,526.00 / $15,288.00 / $23,366.00
| Facility | | $6,526.00 | $15,288.00 | $23,366.00 |