- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $652.46 / $652.46 / $5,618.00
| Facility | | $652.46 | $652.46 | $5,618.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $326.23 / $326.23 / $326.23
| Facility | 52 | $326.23 | $326.23 | $326.23 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $130.49 / $130.49 / $130.49
| Facility | 53 | $130.49 | $130.49 | $130.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,088.66 / $22,802.40 / $44,489.13
| Facility | | $13,088.66 | $22,802.40 | $44,489.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,470.59 / $2,085.48 / $5,016.91
| Facility | | $1,470.59 | $2,085.48 | $5,016.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,195.49 / $1,906.63 / $3,950.33
| Facility | | $1,195.49 | $1,906.63 | $3,950.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.67 / $1,812.19 / $29,378.72
| Facility | | $1,047.67 | $1,812.19 | $29,378.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,577.00 / $10,743.00 / $12,774.00
| Facility | | $5,577.00 | $10,743.00 | $12,774.00 |