- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $38.79 / $4,468.72 / $9,784.00
| Facility | | $38.79 | $4,468.72 | $9,784.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $19.39 / $19.39 / $33.69
| Facility | 52 | $19.39 | $19.39 | $33.69 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $7.76 / $7.76 / $13.48
| Facility | 53 | $7.76 | $7.76 | $13.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $782.90 / $782.90 / $970.14
| Facility | | $782.90 | $782.90 | $970.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,141.00 / $2,607.00 / $5,864.00
| Facility | | $1,141.00 | $2,607.00 | $5,864.00 |