- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $308.31 / $1,305.00 / $3,109.00
| Facility | | $308.31 | $1,305.00 | $3,109.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $123.22 / $154.15 / $177.67
| Facility | 52 | $123.22 | $154.15 | $177.67 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $49.29 / $61.66 / $71.06
| Facility | 53 | $49.29 | $61.66 | $71.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,771.26 / $1,771.26 / $2,019.24
| Facility | | $1,771.26 | $1,771.26 | $2,019.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $490.00 / $515.00 / $930.22
| Facility | | $490.00 | $515.00 | $930.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $505.00 / $1,106.00 / $2,539.00
| Facility | | $505.00 | $1,106.00 | $2,539.00 |