- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $3,630.78 / $9,549.93
| Facility | | $616.60 | $3,630.78 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $1,174.90 / $5,011.87 / $5,011.87
| Facility | 52 | $1,174.90 | $5,011.87 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $5,888.44 / $13,489.63
| Facility | | $2,238.72 | $5,888.44 | $13,489.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $1,122.02 / $3,467.37
| Facility | | $537.03 | $1,122.02 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $436.52 / $436.52 / $436.52
| Facility | 52 | $436.52 | $436.52 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $107.15 / $107.15 / $107.15
| Facility | 53 | $107.15 | $107.15 | $107.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $3,981.07 / $10,000.00
| Facility | | $1,047.13 | $3,981.07 | $10,000.00 |