- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,382.00 / $8,477.27 / $19,276.96
| Facility | | $4,382.00 | $8,477.27 | $19,276.96 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $90.06 / $90.06 / $90.06
| Facility | 53 | $90.06 | $90.06 | $90.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,828.69 / $16,873.23 / $32,638.27
| Facility | | $12,828.69 | $16,873.23 | $32,638.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $574.11 / $855.53 / $26,782.00
| Facility | | $574.11 | $855.53 | $26,782.00 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $8,211.29 / $8,211.29 / $8,211.29
| Facility | 53 | $8,211.29 | $8,211.29 | $8,211.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $893.05 / $1,356.18 / $15,273.28
| Facility | | $893.05 | $1,356.18 | $15,273.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,617.00 / $11,459.00 / $26,782.00
| Facility | | $9,617.00 | $11,459.00 | $26,782.00 |