- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $6,456.54 / $15,135.61
| Facility | | $1,047.13 | $6,456.54 | $15,135.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $25,118.86 / $42,657.95
| Facility | | $776.25 | $25,118.86 | $42,657.95 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $616.60 / $616.60 / $616.60
| Facility | 52 | $616.60 | $616.60 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $154.88 / $154.88 / $154.88
| Facility | 53 | $154.88 | $154.88 | $154.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,168.69 / $4,466.84 / $4,786.30
| Facility | | $4,168.69 | $4,466.84 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,079.46 / $18,620.87 / $38,018.94
| Facility | | $7,079.46 | $18,620.87 | $38,018.94 |