- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,400.00 / $1,512.11 / $3,050.00
| Facility | | $1,400.00 | $1,512.11 | $3,050.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $756.06 / $756.06 / $1,170.71
| Facility | 52 | $756.06 | $756.06 | $1,170.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,613.68 / $1,813.25 / $1,975.56
| Facility | | $1,613.68 | $1,813.25 | $1,975.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,723.69 / $1,723.69 / $1,723.69
| Facility | | $1,723.69 | $1,723.69 | $1,723.69 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $1,362.43 / $1,362.43 / $1,362.43
| Facility | 52 | $1,362.43 | $1,362.43 | $1,362.43 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $170.30 / $170.30 / $170.30
| Facility | AS | $170.30 | $170.30 | $170.30 |