- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $921.06 / $3,245.00 / $9,940.00
| Facility | | $921.06 | $3,245.00 | $9,940.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $460.53 / $460.53 / $547.88
| Facility | 52 | $460.53 | $460.53 | $547.88 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $184.21 / $184.21 / $219.15
| Facility | 53 | $184.21 | $184.21 | $219.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,120.74 / $9,256.86 / $22,392.17
| Facility | | $4,120.74 | $9,256.86 | $22,392.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $789.78 / $789.78 / $789.78
| Facility | | $789.78 | $789.78 | $789.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,141.00 / $4,717.00 / $10,810.00
| Facility | | $1,141.00 | $4,717.00 | $10,810.00 |