- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $356.12 / $3,064.00 / $4,707.00
| Facility | | $356.12 | $3,064.00 | $4,707.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $178.06 / $178.06 / $178.06
| Facility | 52 | $178.06 | $178.06 | $178.06 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $71.22 / $71.22 / $71.22
| Facility | 53 | $71.22 | $71.22 | $71.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,715.47 / $2,237.48 / $3,260.64
| Facility | | $1,715.47 | $2,237.48 | $3,260.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,689.00 / $2,312.00 / $4,640.00
| Facility | | $1,689.00 | $2,312.00 | $4,640.00 |