- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $2,818.38 / $6,606.93
| Facility | | $1,000.00 | $2,818.38 | $6,606.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,801.89 / $5,888.44 / $9,549.93
| Facility | | $3,801.89 | $5,888.44 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $316.23 / $489.78 / $5,495.41
| Facility | | $316.23 | $489.78 | $5,495.41 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $8,128.31 / $8,128.31 / $8,128.31
| Facility | 52 | $8,128.31 | $8,128.31 | $8,128.31 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $1,995.26 / $1,995.26 / $1,995.26
| Facility | 53 | $1,995.26 | $1,995.26 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $3,311.31 / $6,025.60
| Facility | | $891.25 | $3,311.31 | $6,025.60 |