- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $796.86 / $1,100.00 / $2,250.00
| Facility | | $796.86 | $1,100.00 | $2,250.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $398.43 / $398.43 / $398.43
| Facility | 52 | $398.43 | $398.43 | $398.43 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $159.37 / $159.37 / $159.37
| Facility | 53 | $159.37 | $159.37 | $159.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,049.26 / $13,408.80 / $18,039.12
| Facility | | $11,049.26 | $13,408.80 | $18,039.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,200.00 / $8,790.00 / $16,472.00
| Facility | | $4,200.00 | $8,790.00 | $16,472.00 |