- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,305.00 / $9,357.51 / $32,335.00
| Facility | | $4,305.00 | $9,357.51 | $32,335.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $381.55 / $381.55 / $648.40
| Facility | 52 | $381.55 | $381.55 | $648.40 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $152.62 / $152.62 / $259.36
| Facility | 53 | $152.62 | $152.62 | $259.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,453.71 / $3,236.40 / $50,833.00
| Facility | | $1,453.71 | $3,236.40 | $50,833.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,953.00 / $27,808.00 / $45,414.96
| Facility | | $13,953.00 | $27,808.00 | $45,414.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,943.00 / $12,055.00 / $39,943.00
| Facility | | $6,943.00 | $12,055.00 | $39,943.00 |