- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,969.97 / $6,015.52 / $11,627.00
| Facility | | $1,969.97 | $6,015.52 | $11,627.00 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $393.99 / $585.87 / $1,203.09
| Facility | 53 | $393.99 | $585.87 | $1,203.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.99 / $1,831.00 / $3,840.45
| Facility | | $870.99 | $1,831.00 | $3,840.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,715.08 / $1,715.08 / $2,497.39
| Facility | | $1,715.08 | $1,715.08 | $2,497.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,571.00 / $21,571.00 / $21,571.00
| Facility | | $21,571.00 | $21,571.00 | $21,571.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,480.00 / $3,086.00 / $6,792.00
| Facility | | $1,480.00 | $3,086.00 | $6,792.00 |