- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,064.44 / $2,134.64 / $20,243.00
| Facility | | $1,064.44 | $2,134.64 | $20,243.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $532.22 / $532.22 / $1,067.32
| Facility | 52 | $532.22 | $532.22 | $1,067.32 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $212.89 / $212.89 / $426.93
| Facility | 53 | $212.89 | $212.89 | $426.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $804.94 / $1,082.89 / $1,758.03
| Facility | | $804.94 | $1,082.89 | $1,758.03 |
- Facility/Professional
- Facility
- Modifier
- 80
- Low / Median / High Price
- $204.46 / $216.58 / $315.81
| Facility | 80 | $204.46 | $216.58 | $315.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,912.00 / $16,959.00 / $23,485.00
| Facility | | $2,912.00 | $16,959.00 | $23,485.00 |