- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,100.00 / $2,250.00 / $10,095.45
| Facility | | $1,100.00 | $2,250.00 | $10,095.45 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $668.81 / $668.81 / $668.81
| Facility | 52 | $668.81 | $668.81 | $668.81 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $267.52 / $267.52 / $267.52
| Facility | 53 | $267.52 | $267.52 | $267.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,455.92 / $16,329.40 / $21,968.27
| Facility | | $13,455.92 | $16,329.40 | $21,968.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,074.00 / $3,816.00 / $7,227.00
| Facility | | $1,074.00 | $3,816.00 | $7,227.00 |