- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,131.00 / $7,365.00 / $18,600.00
| Facility | | $3,131.00 | $7,365.00 | $18,600.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $920.87 / $920.87 / $1,194.14
| Facility | 52 | $920.87 | $920.87 | $1,194.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,322.00 / $15,633.76 / $19,113.64
| Facility | | $13,322.00 | $15,633.76 | $19,113.64 |
- 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
- $1,364.42 / $2,289.73 / $10,268.00
| Facility | | $1,364.42 | $2,289.73 | $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 |