- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $265.47 / $1,788.76 / $3,487.91
| Facility | | $265.47 | $1,788.76 | $3,487.91 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $173.11 / $470.18 / $470.18
| Facility | 52 | $173.11 | $470.18 | $470.18 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $69.23 / $188.07 / $188.07
| Facility | 53 | $69.23 | $188.07 | $188.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,449.90 / $1,611.00 / $2,875.00
| Facility | | $1,449.90 | $1,611.00 | $2,875.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,751.69 / $1,751.69 / $1,812.99
| Facility | | $1,751.69 | $1,751.69 | $1,812.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $930.00 / $3,884.00 / $8,611.00
| Facility | | $930.00 | $3,884.00 | $8,611.00 |