- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $811.90 / $3,386.61 / $6,161.00
| Facility | | $811.90 | $3,386.61 | $6,161.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $405.95 / $405.95 / $405.95
| Facility | 52 | $405.95 | $405.95 | $405.95 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $608.92 / $608.92 / $608.92
| Facility | 54 | $608.92 | $608.92 | $608.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,304.17 / $3,047.35 / $4,440.85
| Facility | | $2,304.17 | $3,047.35 | $4,440.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,689.00 / $2,312.00 / $4,640.00
| Facility | | $1,689.00 | $2,312.00 | $4,640.00 |