- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $544.22 / $2,922.00 / $4,387.00
| Facility | | $544.22 | $2,922.00 | $4,387.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $272.11 / $272.11 / $272.11
| Facility | 52 | $272.11 | $272.11 | $272.11 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $408.17 / $408.17 / $408.17
| Facility | 54 | $408.17 | $408.17 | $408.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $340.97 / $447.13 / $651.60
| Facility | | $340.97 | $447.13 | $651.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,078.00 / $1,556.00 / $4,495.00
| Facility | | $1,078.00 | $1,556.00 | $4,495.00 |