- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,316.41 / $5,135.00 / $11,627.00
| Facility | | $1,316.41 | $5,135.00 | $11,627.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $442.64 / $658.21 / $1,419.05
| Facility | 52 | $442.64 | $658.21 | $1,419.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,807.00 / $8,566.00 / $60,320.00
| Facility | | $2,807.00 | $8,566.00 | $60,320.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $816.53 / $979.84 / $1,212.75
| Facility | | $816.53 | $979.84 | $1,212.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,571.00 / $21,571.00 / $21,571.00
| Facility | | $21,571.00 | $21,571.00 | $21,571.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,524.00 / $11,766.00 / $20,348.00
| Facility | | $4,524.00 | $11,766.00 | $20,348.00 |