- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $964.13 / $964.13 / $6,575.00
| Facility | | $964.13 | $964.13 | $6,575.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $482.07 / $482.07 / $482.07
| Facility | 52 | $482.07 | $482.07 | $482.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,964.49 / $9,493.79 / $21,331.89
| Facility | | $4,964.49 | $9,493.79 | $21,331.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,249.21 / $3,510.44 / $8,444.85
| Facility | | $2,249.21 | $3,510.44 | $8,444.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.14 / $3,203.51 / $6,649.49
| Facility | | $1,949.14 | $3,203.51 | $6,649.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,027.78 / $1,765.24 / $3,077.98
| Facility | | $1,027.78 | $1,765.24 | $3,077.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $875.00 / $3,940.00 / $10,493.00
| Facility | | $875.00 | $3,940.00 | $10,493.00 |