- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,322.01 / $4,396.00 / $10,300.00
| Facility | | $1,322.01 | $4,396.00 | $10,300.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $661.01 / $661.01 / $661.01
| Facility | 52 | $661.01 | $661.01 | $661.01 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $264.39 / $264.39 / $264.39
| Facility | 53 | $264.39 | $264.39 | $264.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,671.00 / $5,123.00 / $8,352.37
| Facility | | $3,671.00 | $5,123.00 | $8,352.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.52 / $1,284.38 / $1,805.55
| Professional | | $15.52 | $1,284.38 | $1,805.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.00 / $2,578.00 / $6,471.00
| Facility | | $776.00 | $2,578.00 | $6,471.00 |