- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,094.04 / $1,094.04 / $1,094.04
| Facility | | $1,094.04 | $1,094.04 | $1,094.04 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $547.02 / $547.02 / $547.02
| Facility | 52 | $547.02 | $547.02 | $547.02 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $218.81 / $218.81 / $218.81
| Facility | 53 | $218.81 | $218.81 | $218.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,496.15 / $10,442.46 / $21,331.89
| Facility | | $5,496.15 | $10,442.46 | $21,331.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,549.98 / $3,979.86 / $9,574.09
| Facility | | $2,549.98 | $3,979.86 | $9,574.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,209.78 / $3,631.88 / $7,538.65
| Facility | | $2,209.78 | $3,631.88 | $7,538.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,160.14 / $1,954.40 / $3,474.50
| Facility | | $1,160.14 | $1,954.40 | $3,474.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $796.00 / $3,500.00 / $8,152.00
| Facility | | $796.00 | $3,500.00 | $8,152.00 |