- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,534.15 / $7,655.00 / $14,023.00
| Facility | | $2,534.15 | $7,655.00 | $14,023.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $962.02 / $962.02 / $1,267.08
| Facility | 52 | $962.02 | $962.02 | $1,267.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,166.00 / $4,280.76 / $6,787.73
| Facility | | $3,166.00 | $4,280.76 | $6,787.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $914.00 / $914.00 / $914.00
| Facility | | $914.00 | $914.00 | $914.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,575.85 / $2,084.38 / $8,280.00
| Facility | | $1,575.85 | $2,084.38 | $8,280.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,967.00 / $4,960.00 / $11,732.00
| Facility | | $1,967.00 | $4,960.00 | $11,732.00 |