- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,033.08 / $6,644.91 / $14,609.47
| Facility | | $1,033.08 | $6,644.91 | $14,609.47 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $326.01 / $344.42 / $397.36
| Facility | 52 | $326.01 | $344.42 | $397.36 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $130.40 / $137.77 / $207.31
| Facility | 53 | $130.40 | $137.77 | $207.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,731.00 / $17,593.00 / $33,917.00
| Facility | | $5,731.00 | $17,593.00 | $33,917.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,300.00 / $14,154.50 / $23,045.50
| Facility | | $8,300.00 | $14,154.50 | $23,045.50 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $575.63 / $575.63 / $575.63
| Facility | 52 | $575.63 | $575.63 | $575.63 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $143.91 / $143.91 / $143.91
| Facility | 53 | $143.91 | $143.91 | $143.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,062.00 / $11,540.00 / $26,502.00
| Facility | | $4,062.00 | $11,540.00 | $26,502.00 |