- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $475.86 / $1,836.00 / $13,166.00
| Facility | | $475.86 | $1,836.00 | $13,166.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $206.91 / $206.91 / $1,032.35
| Facility | 52 | $206.91 | $206.91 | $1,032.35 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $82.76 / $82.76 / $412.94
| Facility | 53 | $82.76 | $82.76 | $412.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $531.01 / $531.01 / $584.10
| Facility | | $531.01 | $531.01 | $584.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $31,086.00 / $31,086.00 / $31,086.00
| Facility | | $31,086.00 | $31,086.00 | $31,086.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,390.00 / $10,905.00 / $19,044.00
| Facility | | $1,390.00 | $10,905.00 | $19,044.00 |