- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $4,187.47 / $4,187.47
| Facility | | $100.00 | $4,187.47 | $4,187.47 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $1,067.30 / $2,093.73 / $2,093.73
| Facility | 52 | $1,067.30 | $2,093.73 | $2,093.73 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $426.92 / $837.49 / $837.49
| Facility | 53 | $426.92 | $837.49 | $837.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,476.90 / $9,132.04 / $17,364.89
| Facility | | $3,476.90 | $9,132.04 | $17,364.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $451.00 / $3,360.00 / $7,448.00
| Facility | | $451.00 | $3,360.00 | $7,448.00 |