- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $472.54 / $3,064.00 / $4,707.00
| Facility | | $472.54 | $3,064.00 | $4,707.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $236.27 / $236.27 / $236.27
| Facility | 52 | $236.27 | $236.27 | $236.27 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $94.51 / $94.51 / $94.51
| Facility | 53 | $94.51 | $94.51 | $94.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,327.48 / $7,261.43 / $10,581.98
| Facility | | $5,327.48 | $7,261.43 | $10,581.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,981.00 / $3,613.00 / $7,048.00
| Facility | | $1,981.00 | $3,613.00 | $7,048.00 |