- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $568.02 / $1,821.00 / $13,016.00
| Facility | | $568.02 | $1,821.00 | $13,016.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $284.01 / $286.00 / $408.93
| Facility | 52 | $284.01 | $286.00 | $408.93 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $113.60 / $114.40 / $163.57
| Facility | 53 | $113.60 | $114.40 | $163.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,781.00 / $8,781.00 / $20,598.28
| Facility | | $8,781.00 | $8,781.00 | $20,598.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,079.00 / $8,643.00 / $15,659.00
| Facility | | $3,079.00 | $8,643.00 | $15,659.00 |