- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $7,838.38 / $8,942.39
| Facility | | $1,000.00 | $7,838.38 | $8,942.39 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $204.88 / $204.88 / $204.88
| Facility | 52 | $204.88 | $204.88 | $204.88 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $81.95 / $81.95 / $81.95
| Facility | 53 | $81.95 | $81.95 | $81.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,233.10 / $19,751.29 / $33,088.67
| Facility | | $8,233.10 | $19,751.29 | $33,088.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,028.00 / $27,649.00 / $27,649.00
| Facility | | $9,028.00 | $27,649.00 | $27,649.00 |