- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $157.76 / $2,341.64
| Facility | | $100.00 | $157.76 | $2,341.64 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $34.61 / $78.88 / $78.88
| Facility | 52 | $34.61 | $78.88 | $78.88 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $13.85 / $31.55 / $31.55
| Facility | 53 | $13.85 | $31.55 | $31.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,223.09 / $1,426.62 / $2,500.00
| Facility | | $1,223.09 | $1,426.62 | $2,500.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $75.00 / $3,360.00 / $7,448.00
| Facility | | $75.00 | $3,360.00 | $7,448.00 |