- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $750.00 / $3,000.00 / $10,095.45
| Facility | | $750.00 | $3,000.00 | $10,095.45 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $347.42 / $347.42 / $1,733.44
| Facility | 52 | $347.42 | $347.42 | $1,733.44 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $138.97 / $138.97 / $693.37
| Facility | 53 | $138.97 | $138.97 | $693.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,000.00 / $1,000.00
| Facility | | $1,000.00 | $1,000.00 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $985.00 / $3,956.00 / $10,251.00
| Facility | | $985.00 | $3,956.00 | $10,251.00 |