- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $477.90 / $1,064.00 / $2,812.00
| Facility | | $477.90 | $1,064.00 | $2,812.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $229.62 / $238.95 / $265.61
| Facility | 52 | $229.62 | $238.95 | $265.61 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $344.43 / $358.43 / $398.41
| Facility | 54 | $344.43 | $358.43 | $398.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $210.54 / $210.54 / $252.65
| Facility | | $210.54 | $210.54 | $252.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $167.26 / $167.26 / $167.26
| Facility | | $167.26 | $167.26 | $167.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $130.00 / $328.00 / $768.00
| Facility | | $130.00 | $328.00 | $768.00 |