- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $312.94 / $1,305.00 / $3,804.00
| Facility | | $312.94 | $1,305.00 | $3,804.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $156.47 / $156.47 / $254.12
| Facility | 52 | $156.47 | $156.47 | $254.12 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $62.59 / $62.59 / $101.65
| Facility | 53 | $62.59 | $62.59 | $101.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,101.34 / $1,101.34 / $1,255.54
| Facility | | $1,101.34 | $1,101.34 | $1,255.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $515.00 / $561.00 / $681.35
| Facility | | $515.00 | $561.00 | $681.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $505.00 / $1,106.00 / $2,539.00
| Facility | | $505.00 | $1,106.00 | $2,539.00 |