- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $960.00 / $1,728.00 / $2,467.59
| Facility | | $960.00 | $1,728.00 | $2,467.59 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $1,233.80 / $1,233.80 / $1,233.80
| Facility | 52 | $1,233.80 | $1,233.80 | $1,233.80 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $493.52 / $493.52 / $493.52
| Facility | 53 | $493.52 | $493.52 | $493.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,718.36 / $8,153.05 / $10,968.47
| Facility | | $6,718.36 | $8,153.05 | $10,968.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $650.00 / $1,754.00 / $4,083.00
| Facility | | $650.00 | $1,754.00 | $4,083.00 |