- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $2,398.83 / $8,128.31
| Facility | | $489.78 | $2,398.83 | $8,128.31 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $851.14 / $851.14 / $851.14
| Facility | 52 | $851.14 | $851.14 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $316.23 / $316.23 / $1,318.26
| Facility | 54 | $316.23 | $316.23 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $3,630.78 / $8,709.64
| Facility | | $1,445.44 | $3,630.78 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $354.81 / $891.25 / $3,090.30
| Facility | | $354.81 | $891.25 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $575.44 / $575.44 / $575.44
| Facility | 52 | $575.44 | $575.44 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $501.19 / $501.19 / $501.19
| Facility | 54 | $501.19 | $501.19 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $204.17 / $1,071.52 / $3,467.37
| Facility | | $204.17 | $1,071.52 | $3,467.37 |