- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $615.00 / $1,223.00 / $2,250.00
| Facility | | $615.00 | $1,223.00 | $2,250.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $252.39 / $252.39 / $252.39
| Facility | 52 | $252.39 | $252.39 | $252.39 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $100.95 / $100.95 / $100.95
| Facility | 53 | $100.95 | $100.95 | $100.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,292.50 / $1,568.51 / $2,110.16
| Facility | | $1,292.50 | $1,568.51 | $2,110.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $625.00 / $1,738.00 / $3,360.00
| Facility | | $625.00 | $1,738.00 | $3,360.00 |