- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $591.67 / $1,831.00 / $11,416.68
| Facility | | $591.67 | $1,831.00 | $11,416.68 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $295.83 / $295.83 / $498.00
| Facility | 52 | $295.83 | $295.83 | $498.00 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $118.34 / $118.34 / $199.20
| Facility | 53 | $118.34 | $118.34 | $199.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,900.00 / $3,753.37 / $7,893.39
| Facility | | $2,900.00 | $3,753.37 | $7,893.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,185.00 / $5,974.00 / $12,332.00
| Facility | | $1,185.00 | $5,974.00 | $12,332.00 |