- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.46 / $2,744.00 / $4,626.00
| Facility | | $55.46 | $2,744.00 | $4,626.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $27.73 / $27.73 / $27.73
| Facility | 52 | $27.73 | $27.73 | $27.73 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $11.09 / $11.09 / $11.09
| Facility | 53 | $11.09 | $11.09 | $11.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $539.07 / $755.46 / $1,100.93
| Facility | | $539.07 | $755.46 | $1,100.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $658.00 / $4,445.00 / $4,912.00
| Facility | | $658.00 | $4,445.00 | $4,912.00 |