- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $426.63 / $1,305.00 / $3,322.34
| Facility | | $426.63 | $1,305.00 | $3,322.34 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $200.17 / $213.32 / $288.50
| Facility | 52 | $200.17 | $213.32 | $288.50 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $80.06 / $85.33 / $115.40
| Facility | 53 | $80.06 | $85.33 | $115.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,316.23 / $3,316.23 / $3,780.50
| Facility | | $3,316.23 | $3,316.23 | $3,780.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $490.00 / $515.00 / $2,281.67
| Facility | | $490.00 | $515.00 | $2,281.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $821.00 / $1,485.00 / $3,384.00
| Facility | | $821.00 | $1,485.00 | $3,384.00 |