- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $551.33 / $3,045.50 / $7,321.50
| Facility | | $551.33 | $3,045.50 | $7,321.50 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $133.18 / $156.29 / $210.70
| Facility | 52 | $133.18 | $156.29 | $210.70 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $53.27 / $62.52 / $84.28
| Facility | 53 | $53.27 | $62.52 | $84.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,449.90 / $3,693.00 / $8,240.00
| Facility | | $1,449.90 | $3,693.00 | $8,240.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.00 / $740.28 / $1,231.60
| Facility | | $512.00 | $740.28 | $1,231.60 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $221.01 / $221.01 / $221.01
| Facility | 52 | $221.01 | $221.01 | $221.01 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $55.25 / $55.25 / $55.25
| Facility | 53 | $55.25 | $55.25 | $55.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $815.50 / $2,322.00 / $5,253.50
| Facility | | $815.50 | $2,322.00 | $5,253.50 |