- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,700.00 / $7,365.00 / $13,151.00
| Facility | | $1,700.00 | $7,365.00 | $13,151.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $767.02 / $767.02 / $1,004.58
| Facility | 52 | $767.02 | $767.02 | $1,004.58 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $306.81 / $306.81 / $401.83
| Facility | 53 | $306.81 | $306.81 | $401.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $914.00 / $914.00 / $914.00
| Facility | | $914.00 | $914.00 | $914.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,058.59 / $1,491.43 / $2,399.86
| Facility | | $1,058.59 | $1,491.43 | $2,399.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $783.00 / $1,743.00 / $5,562.00
| Facility | | $783.00 | $1,743.00 | $5,562.00 |