- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $343.13 / $2,711.43 / $4,387.00
| Facility | | $343.13 | $2,711.43 | $4,387.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $171.57 / $171.57 / $171.57
| Facility | 52 | $171.57 | $171.57 | $171.57 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $68.63 / $68.63 / $68.63
| Facility | 53 | $68.63 | $68.63 | $68.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,686.94 / $3,607.85 / $5,257.67
| Facility | | $2,686.94 | $3,607.85 | $5,257.67 |
- 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 |