- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $7,413.10 / $25,703.96
| Facility | | $1,412.54 | $7,413.10 | $25,703.96 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $9,772.37 / $10,000.00 / $13,489.63
| Facility | 53 | $9,772.37 | $10,000.00 | $13,489.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,165.95 / $17,782.79 / $43,651.58
| Facility | | $6,165.95 | $17,782.79 | $43,651.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $16,595.87 / $38,018.94
| Facility | | $3,235.94 | $16,595.87 | $38,018.94 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $1,258.93 / $1,258.93 / $1,258.93
| Facility | 22 | $1,258.93 | $1,258.93 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $831.76 / $831.76 / $831.76
| Facility | 52 | $831.76 | $831.76 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $208.93 / $208.93 / $208.93
| Facility | 53 | $208.93 | $208.93 | $208.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $12,022.64 / $33,884.42
| Facility | | $3,019.95 | $12,022.64 | $33,884.42 |