- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $735.11 / $5,016.50 / $15,865.50
| Facility | | $735.11 | $5,016.50 | $15,865.50 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $259.10 / $276.47 / $362.93
| Facility | 52 | $259.10 | $276.47 | $362.93 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $103.64 / $110.59 / $145.17
| Facility | 53 | $103.64 | $110.59 | $145.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,793.00 / $15,494.00 / $21,079.00
| Facility | | $6,793.00 | $15,494.00 | $21,079.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,293.00 / $15,640.00 / $21,571.00
| Facility | | $10,293.00 | $15,640.00 | $21,571.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $402.94 / $402.94 / $402.94
| Facility | 52 | $402.94 | $402.94 | $402.94 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $100.74 / $100.74 / $100.74
| Facility | 53 | $100.74 | $100.74 | $100.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,029.00 / $12,981.00 / $31,027.00
| Facility | | $5,029.00 | $12,981.00 | $31,027.00 |