- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $785.42 / $3,101.00 / $7,209.00
| Facility | | $785.42 | $3,101.00 | $7,209.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $328.17 / $328.17 / $392.71
| Facility | 52 | $328.17 | $328.17 | $392.71 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $131.27 / $131.27 / $157.08
| Facility | 53 | $131.27 | $131.27 | $157.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,561.55 / $10,572.96 / $18,725.81
| Facility | | $5,561.55 | $10,572.96 | $18,725.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,551.93 / $5,551.93 / $5,551.93
| Facility | | $5,551.93 | $5,551.93 | $5,551.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,656.00 / $8,813.00 / $19,124.00
| Facility | | $5,656.00 | $8,813.00 | $19,124.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,200.00 / $5,780.00 / $14,288.00
| Facility | | $1,200.00 | $5,780.00 | $14,288.00 |