- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.03 / $2,056.00 / $4,933.00
| Facility | | $1,023.03 | $2,056.00 | $4,933.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $511.52 / $511.52 / $511.52
| Facility | 52 | $511.52 | $511.52 | $511.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,748.82 / $25,387.42 / $34,584.65
| Facility | | $21,748.82 | $25,387.42 | $34,584.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $820.20 / $2,056.00 / $4,933.00
| Facility | | $820.20 | $2,056.00 | $4,933.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $511.52 / $511.52 / $511.52
| Facility | 52 | $511.52 | $511.52 | $511.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,489.00 / $12,457.00 / $14,805.00
| Facility | | $7,489.00 | $12,457.00 | $14,805.00 |