- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,277.00 / $1,688.00 / $3,109.00
| Facility | | $1,277.00 | $1,688.00 | $3,109.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $711.20 / $731.71 / $1,069.90
| Facility | 52 | $711.20 | $731.71 | $1,069.90 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $284.48 / $292.68 / $427.96
| Facility | 53 | $284.48 | $292.68 | $427.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $515.00 / $541.00 / $561.00
| Facility | | $515.00 | $541.00 | $561.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $375.00 / $750.00 / $2,558.00
| Facility | | $375.00 | $750.00 | $2,558.00 |