- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $399.30 / $1,251.00 / $2,639.00
| Facility | | $399.30 | $1,251.00 | $2,639.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $199.65 / $199.65 / $199.65
| Facility | 52 | $199.65 | $199.65 | $199.65 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $79.86 / $79.86 / $79.86
| Facility | 53 | $79.86 | $79.86 | $79.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,273.48 / $1,545.43 / $2,079.10
| Facility | | $1,273.48 | $1,545.43 | $2,079.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $500.00 / $1,754.00 / $3,200.00
| Facility | | $500.00 | $1,754.00 | $3,200.00 |