- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,037.35 / $4,797.00 / $5,029.59
| Facility | | $1,037.35 | $4,797.00 | $5,029.59 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $518.67 / $518.67 / $537.89
| Facility | 52 | $518.67 | $518.67 | $537.89 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $207.47 / $207.47 / $215.16
| Facility | 53 | $207.47 | $207.47 | $215.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,804.24 / $4,433.97 / $6,007.33
| Facility | | $3,804.24 | $4,433.97 | $6,007.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $835.38 / $4,797.00 / $4,933.00
| Facility | | $835.38 | $4,797.00 | $4,933.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $518.67 / $518.67 / $518.67
| Facility | 52 | $518.67 | $518.67 | $518.67 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $207.47 / $207.47 / $207.47
| Facility | 53 | $207.47 | $207.47 | $207.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,069.00 / $8,702.00 / $12,726.00
| Facility | | $4,069.00 | $8,702.00 | $12,726.00 |