- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $2,761.00 / $7,838.38
| Facility | | $1,000.00 | $2,761.00 | $7,838.38 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $411.72 / $455.07 / $627.43
| Facility | 52 | $411.72 | $455.07 | $627.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,734.00 / $8,566.00 / $21,862.00
| Facility | | $4,734.00 | $8,566.00 | $21,862.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,071.83 / $17,711.83 / $19,022.85
| Facility | | $17,071.83 | $17,711.83 | $19,022.85 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $718.20 / $718.20 / $718.20
| Facility | 52 | $718.20 | $718.20 | $718.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,685.00 / $12,457.00 / $25,304.00
| Facility | | $4,685.00 | $12,457.00 | $25,304.00 |