- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $223.73 / $4,790.00 / $11,576.00
| Facility | | $223.73 | $4,790.00 | $11,576.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $103.72 / $107.51 / $119.54
| Facility | 52 | $103.72 | $107.51 | $119.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $273.83 / $457.32 / $2,530.00
| Facility | | $273.83 | $457.32 | $2,530.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $213.26 / $213.26 / $213.26
| Facility | 52 | $213.26 | $213.26 | $213.26 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $26.66 / $26.66 / $26.66
| Facility | AS | $26.66 | $26.66 | $26.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,600.00 / $19,859.00 / $31,911.00
| Facility | | $6,600.00 | $19,859.00 | $31,911.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $573.00 / $4,414.00 / $9,150.00
| Facility | | $573.00 | $4,414.00 | $9,150.00 |