- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,914.43 / $1,999.93 / $4,846.00
| Facility | | $1,914.43 | $1,999.93 | $4,846.00 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $382.89 / $399.99 / $526.08
| Facility | 53 | $382.89 | $399.99 | $526.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,604.57 / $2,341.13 / $13,810.27
| Facility | | $1,604.57 | $2,341.13 | $13,810.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,587.58 / $2,023.39 / $2,334.67
| Facility | | $1,587.58 | $2,023.39 | $2,334.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,403.00 / $5,242.00 / $10,843.00
| Facility | | $1,403.00 | $5,242.00 | $10,843.00 |