- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $750.00 / $1,831.00 / $2,825.00
| Facility | | $750.00 | $1,831.00 | $2,825.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $566.29 / $566.29 / $1,733.19
| Facility | 52 | $566.29 | $566.29 | $1,733.19 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $226.52 / $226.52 / $693.28
| Facility | 53 | $226.52 | $226.52 | $693.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.00 / $1,000.00 / $1,000.00
| Facility | | $588.00 | $1,000.00 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $624.00 / $1,223.00 / $5,253.00
| Facility | | $624.00 | $1,223.00 | $5,253.00 |