- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,144.36 / $2,897.00 / $6,483.00
| Facility | | $1,144.36 | $2,897.00 | $6,483.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $587.35 / $2,197.38 / $3,616.69
| Facility | | $587.35 | $2,197.38 | $3,616.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.32 / $749.86 / $3,134.00
| Facility | | $562.32 | $749.86 | $3,134.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $1,200.66 / $1,200.66 / $3,605.48
| Facility | 52 | $1,200.66 | $1,200.66 | $3,605.48 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $1,050.58 / $1,050.58 / $3,154.80
| Facility | 54 | $1,050.58 | $1,050.58 | $3,154.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.00 / $2,567.00 / $5,029.00
| Facility | | $1,584.00 | $2,567.00 | $5,029.00 |