- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $546.05 / $2,294.90 / $7,212.00
| Facility | | $546.05 | $2,294.90 | $7,212.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $273.02 / $273.02 / $448.17
| Facility | 52 | $273.02 | $273.02 | $448.17 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $409.55 / $409.55 / $672.26
| Facility | 54 | $409.55 | $409.55 | $672.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,943.00 / $5,126.00 / $8,240.00
| Facility | | $1,943.00 | $5,126.00 | $8,240.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $563.53 / $742.53 / $1,113.80
| Facility | | $563.53 | $742.53 | $1,113.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,123.45 / $1,123.45 / $1,331.74
| Facility | | $1,123.45 | $1,123.45 | $1,331.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,400.00 / $3,874.00 / $5,490.00
| Facility | | $2,400.00 | $3,874.00 | $5,490.00 |