- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $982.81 / $4,230.00 / $9,870.00
| Facility | | $982.81 | $4,230.00 | $9,870.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $491.41 / $491.41 / $1,112.33
| Facility | 52 | $491.41 | $491.41 | $1,112.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,497.72 / $35,070.93 / $62,507.33
| Facility | | $14,497.72 | $35,070.93 | $62,507.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $375.00 / $21,600.05 / $27,756.46
| Facility | | $375.00 | $21,600.05 | $27,756.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $787.39 / $1,088.08 / $1,782.12
| Facility | | $787.39 | $1,088.08 | $1,782.12 |
- Facility/Professional
- Facility
- Modifier
- 80
- Low / Median / High Price
- $186.60 / $217.62 / $301.92
| Facility | 80 | $186.60 | $217.62 | $301.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,960.00 / $23,639.00 / $35,711.00
| Facility | | $3,960.00 | $23,639.00 | $35,711.00 |