- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,632.40 / $3,921.00 / $7,467.00
| Facility | | $1,632.40 | $3,921.00 | $7,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $632.79 / $2,362.71 / $4,140.09
| Facility | | $632.79 | $2,362.71 | $4,140.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,581.36 / $4,735.83 / $7,759.61
| Facility | | $3,581.36 | $4,735.83 | $7,759.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $204.24 / $273.05 / $4,655.00
| Facility | | $204.24 | $273.05 | $4,655.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $438.30 / $18,115.80 / $18,115.80
| Facility | 52 | $438.30 | $18,115.80 | $18,115.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,424.00 / $4,352.00 / $7,217.00
| Facility | | $1,424.00 | $4,352.00 | $7,217.00 |