- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $7,762.47 / $25,118.86
| Facility | | $1,096.48 | $7,762.47 | $25,118.86 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $2,754.23 / $3,467.37 / $27,542.29
| Facility | 52 | $2,754.23 | $3,467.37 | $27,542.29 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $10,715.19 / $10,715.19 / $10,715.19
| Facility | 53 | $10,715.19 | $10,715.19 | $10,715.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,165.95 / $16,982.44 / $41,686.94
| Facility | | $6,165.95 | $16,982.44 | $41,686.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $16,218.10 / $37,153.52
| Facility | | $1,862.09 | $16,218.10 | $37,153.52 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $1,000.00 / $1,000.00 / $1,000.00
| Facility | 22 | $1,000.00 | $1,000.00 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $676.08 / $676.08 / $676.08
| Facility | 52 | $676.08 | $676.08 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $169.82 / $169.82 / $169.82
| Facility | 53 | $169.82 | $169.82 | $169.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $10,964.78 / $27,542.29
| Facility | | $3,019.95 | $10,964.78 | $27,542.29 |