- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.19 / $3,101.00 / $6,210.00
| Facility | | $870.19 | $3,101.00 | $6,210.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $410.53 / $410.53 / $491.24
| Facility | 52 | $410.53 | $410.53 | $491.24 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $164.21 / $164.21 / $196.49
| Facility | 53 | $164.21 | $164.21 | $196.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,439.57 / $19,855.59 / $29,265.25
| Facility | | $10,439.57 | $19,855.59 | $29,265.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,231.89 / $9,231.89 / $9,231.89
| Facility | | $9,231.89 | $9,231.89 | $9,231.89 |
- 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 / $13,506.00
| Facility | | $1,200.00 | $5,780.00 | $13,506.00 |