- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $828.62 / $2,344.00 / $11,330.00
| Facility | | $828.62 | $2,344.00 | $11,330.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $414.31 / $414.31 / $703.88
| Facility | 52 | $414.31 | $414.31 | $703.88 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $165.72 / $165.72 / $281.55
| Facility | 53 | $165.72 | $165.72 | $281.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,796.13 / $10,796.13 / $12,955.36
| Facility | | $10,796.13 | $10,796.13 | $12,955.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,125.00 / $8,439.00 / $9,992.00
| Facility | | $3,125.00 | $8,439.00 | $9,992.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,104.00 / $4,663.00 / $10,818.00
| Facility | | $2,104.00 | $4,663.00 | $10,818.00 |