- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,100.00 / $6,060.00 / $18,566.00
| Facility | | $2,100.00 | $6,060.00 | $18,566.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,763.75 / $6,640.00 / $10,860.55
| Facility | | $1,763.75 | $6,640.00 | $10,860.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,398.62 / $1,873.42 / $15,622.00
| Facility | | $1,398.62 | $1,873.42 | $15,622.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $2,956.24 / $2,956.24 / $5,369.79
| Facility | 52 | $2,956.24 | $2,956.24 | $5,369.79 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $369.53 / $369.53 / $671.22
| Facility | AS | $369.53 | $369.53 | $671.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,560.00 / $10,420.00 / $22,633.00
| Facility | | $3,560.00 | $10,420.00 | $22,633.00 |