- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,884.10 / $3,821.00 / $8,373.50
| Facility | | $1,884.10 | $3,821.00 | $8,373.50 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $401.76 / $419.29 / $568.97
| Facility | 53 | $401.76 | $419.29 | $568.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,604.57 / $2,937.55 / $10,382.04
| Facility | | $1,604.57 | $2,937.55 | $10,382.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,020.20 / $2,020.20 / $5,003.11
| Facility | | $2,020.20 | $2,020.20 | $5,003.11 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $394.00 / $394.00 / $394.00
| Facility | 53 | $394.00 | $394.00 | $394.00 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $1,231.24 / $1,231.24 / $1,231.24
| Facility | 62 | $1,231.24 | $1,231.24 | $1,231.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,292.00 / $3,325.00 / $8,152.00
| Facility | | $1,292.00 | $3,325.00 | $8,152.00 |