- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $663.18 / $2,333.00 / $8,759.96
| Facility | | $663.18 | $2,333.00 | $8,759.96 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $331.59 / $331.59 / $563.69
| Facility | 52 | $331.59 | $331.59 | $563.69 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $132.63 / $132.63 / $225.48
| Facility | 53 | $132.63 | $132.63 | $225.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,304.24 / $5,304.24 / $6,365.09
| Facility | | $5,304.24 | $5,304.24 | $6,365.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,125.00 / $8,439.00 / $9,992.00
| Facility | | $3,125.00 | $8,439.00 | $9,992.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,104.00 / $4,663.00 / $8,929.00
| Facility | | $2,104.00 | $4,663.00 | $8,929.00 |