- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,400.00 / $1,726.10 / $2,664.83
| Facility | | $1,400.00 | $1,726.10 | $2,664.83 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $863.05 / $863.05 / $1,332.42
| Facility | 52 | $863.05 | $863.05 | $1,332.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,839.35 / $2,063.71 / $2,248.44
| Facility | | $1,839.35 | $2,063.71 | $2,248.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,967.28 / $1,967.28 / $1,967.28
| Facility | | $1,967.28 | $1,967.28 | $1,967.28 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $1,554.50 / $1,554.50 / $1,554.50
| Facility | 52 | $1,554.50 | $1,554.50 | $1,554.50 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $194.31 / $194.31 / $194.31
| Facility | AS | $194.31 | $194.31 | $194.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $43,859.65 / $43,859.65 / $43,859.65
| Facility | | $43,859.65 | $43,859.65 | $43,859.65 |