- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $607.75 / $3,683.00 / $18,600.00
| Facility | | $607.75 | $3,683.00 | $18,600.00 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $121.55 / $121.55 / $121.55
| Facility | 53 | $121.55 | $121.55 | $121.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,628.16 / $30,959.35 / $49,267.55
| Facility | | $19,628.16 | $30,959.35 | $49,267.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,516.00 / $5,516.00 / $15,917.00
| Facility | | $5,516.00 | $5,516.00 | $15,917.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $607.75 / $3,541.00 / $19,803.41
| Facility | | $607.75 | $3,541.00 | $19,803.41 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $6,350.80 / $6,350.80 / $6,350.80
| Facility | 53 | $6,350.80 | $6,350.80 | $6,350.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,570.00 / $7,307.00 / $18,862.37
| Facility | | $1,570.00 | $7,307.00 | $18,862.37 |