- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,707.00 / $9,175.00 / $46,444.00
| Facility | | $3,707.00 | $9,175.00 | $46,444.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $386.88 / $386.88 / $437.27
| Facility | 52 | $386.88 | $386.88 | $437.27 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $154.75 / $154.75 / $174.91
| Facility | 53 | $154.75 | $154.75 | $174.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,646.00 / $21,733.12 / $80,690.00
| Facility | | $5,646.00 | $21,733.12 | $80,690.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,419.00 / $11,674.00 / $35,418.00
| Facility | | $7,419.00 | $11,674.00 | $35,418.00 |