- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $809.66 / $1,268.00 / $39,558.48
| Facility | | $809.66 | $1,268.00 | $39,558.48 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $161.93 / $161.93 / $161.93
| Facility | 53 | $161.93 | $161.93 | $161.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,449.67 / $13,894.72 / $18,692.84
| Facility | | $11,449.67 | $13,894.72 | $18,692.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,250.00 / $11,123.00 / $13,458.00
| Facility | | $5,250.00 | $11,123.00 | $13,458.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,404.00 / $6,113.00 / $15,920.00
| Facility | | $1,404.00 | $6,113.00 | $15,920.00 |