- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,387.00 / $8,177.00 / $11,965.43
| Facility | | $4,387.00 | $8,177.00 | $11,965.43 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $496.21 / $496.21 / $496.21
| Facility | 52 | $496.21 | $496.21 | $496.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,177.00 / $8,177.00 / $8,177.00
| Facility | | $8,177.00 | $8,177.00 | $8,177.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,370.62 / $10,940.20 / $15,943.01
| Facility | | $8,370.62 | $10,940.20 | $15,943.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,028.00 / $8,177.00 / $15,174.00
| Facility | | $3,028.00 | $8,177.00 | $15,174.00 |