- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,481.00 / $7,584.39 / $8,644.27
| Facility | | $2,481.00 | $7,584.39 | $8,644.27 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $701.84 / $701.84 / $701.84
| Facility | 52 | $701.84 | $701.84 | $701.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,951.50 / $38,267.83 / $60,931.93
| Facility | | $15,951.50 | $38,267.83 | $60,931.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,757.87 / $2,237.30 / $2,691.41
| Facility | | $1,757.87 | $2,237.30 | $2,691.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,609.00 / $21,608.00 / $23,186.00
| Facility | | $10,609.00 | $21,608.00 | $23,186.00 |