- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.11 / $8,128.31 / $54,954.09
| Facility | | $1,479.11 | $8,128.31 | $54,954.09 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $27,542.29 / $27,542.29 / $27,542.29
| Facility | 52 | $27,542.29 | $27,542.29 | $27,542.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,165.95 / $16,982.44 / $91,201.08
| Facility | | $6,165.95 | $16,982.44 | $91,201.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $741.31 / $15,135.61
| Facility | | $741.31 | $741.31 | $15,135.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,489.63 / $25,703.96 / $53,703.18
| Facility | | $13,489.63 | $25,703.96 | $53,703.18 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $1,000.00 / $1,000.00 / $1,000.00
| Facility | 22 | $1,000.00 | $1,000.00 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $676.08 / $676.08 / $676.08
| Facility | 52 | $676.08 | $676.08 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $169.82 / $169.82 / $169.82
| Facility | 53 | $169.82 | $169.82 | $169.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $758.58 / $1,513.56
| Facility | | $467.74 | $758.58 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $7,762.47 / $16,595.87
| Facility | | $4,570.88 | $7,762.47 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $16,982.44 / $75,857.76
| Facility | | $616.60 | $16,982.44 | $75,857.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $12,882.50 / $33,113.11
| Facility | | $2,884.03 | $12,882.50 | $33,113.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.87 / $707.95 / $1,023.29
| Facility | | $416.87 | $707.95 | $1,023.29 |