- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $1,309.30 / $2,861.32
| Facility | | $100.00 | $1,309.30 | $2,861.32 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $277.75 / $654.65 / $654.65
| Facility | 52 | $277.75 | $654.65 | $654.65 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $111.10 / $261.86 / $261.86
| Facility | 53 | $111.10 | $261.86 | $261.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,302.10 / $3,669.00 / $6,000.00
| Facility | | $3,302.10 | $3,669.00 | $6,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,751.69 / $1,751.69 / $1,812.99
| Facility | | $1,751.69 | $1,751.69 | $1,812.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $691.00 / $4,314.00 / $9,565.00
| Facility | | $691.00 | $4,314.00 | $9,565.00 |