- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $647.49 / $1,746.00 / $2,729.00
| Facility | | $647.49 | $1,746.00 | $2,729.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $323.75 / $323.75 / $2,739.10
| Facility | 52 | $323.75 | $323.75 | $2,739.10 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $129.50 / $129.50 / $129.50
| Facility | 53 | $129.50 | $129.50 | $129.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,449.67 / $13,894.72 / $18,692.84
| Facility | | $11,449.67 | $13,894.72 | $18,692.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,250.00 / $11,123.00 / $13,458.00
| Facility | | $5,250.00 | $11,123.00 | $13,458.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,404.00 / $5,813.00 / $12,756.00
| Facility | | $1,404.00 | $5,813.00 | $12,756.00 |