- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $693.62 / $1,277.00 / $3,804.00
| Facility | | $693.62 | $1,277.00 | $3,804.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $340.83 / $346.81 / $386.22
| Facility | 52 | $340.83 | $346.81 | $386.22 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $511.24 / $520.22 / $579.34
| Facility | 54 | $511.24 | $520.22 | $579.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,458.96 / $1,458.96 / $1,750.75
| Facility | | $1,458.96 | $1,458.96 | $1,750.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,543.14 / $1,543.14 / $1,543.14
| Facility | | $1,543.14 | $1,543.14 | $1,543.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $590.00 / $1,229.00 / $2,539.00
| Facility | | $590.00 | $1,229.00 | $2,539.00 |