- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,095.00 / $4,521.00 / $20,683.00
| Facility | | $2,095.00 | $4,521.00 | $20,683.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,341.54 / $4,934.39 / $8,070.83
| Facility | | $1,341.54 | $4,934.39 | $8,070.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,068.70 / $14,068.70 / $14,068.70
| Facility | | $14,068.70 | $14,068.70 | $14,068.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $521.10 / $818.80 / $32,991.00
| Facility | | $521.10 | $818.80 | $32,991.00 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $246.60 / $246.60 / $8,211.29
| Facility | 53 | $246.60 | $246.60 | $8,211.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,962.00 / $23,522.00 / $139,004.00
| Facility | | $7,962.00 | $23,522.00 | $139,004.00 |