- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $642.07 / $1,223.00 / $2,250.00
| Facility | | $642.07 | $1,223.00 | $2,250.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $321.04 / $321.04 / $321.04
| Facility | 52 | $321.04 | $321.04 | $321.04 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $128.41 / $128.41 / $128.41
| Facility | 53 | $128.41 | $128.41 | $128.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,397.96 / $4,123.58 / $5,547.54
| Facility | | $3,397.96 | $4,123.58 | $5,547.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $750.00 / $2,769.00 / $4,402.00
| Facility | | $750.00 | $2,769.00 | $4,402.00 |