- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $2,331.21 / $6,067.00
| Facility | | $100.00 | $2,331.21 | $6,067.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $216.34 / $216.34 / $216.34
| Facility | 52 | $216.34 | $216.34 | $216.34 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $86.54 / $86.54 / $86.54
| Facility | 53 | $86.54 | $86.54 | $86.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,449.90 / $1,611.00 / $2,875.00
| Facility | | $1,449.90 | $1,611.00 | $2,875.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,472.40 / $2,472.40 / $2,558.92
| Facility | | $2,472.40 | $2,472.40 | $2,558.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $930.00 / $3,884.00 / $8,611.00
| Facility | | $930.00 | $3,884.00 | $8,611.00 |