- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,788.74 / $3,706.14 / $7,838.38
| Facility | | $1,788.74 | $3,706.14 | $7,838.38 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $916.61 / $1,006.09 / $1,463.53
| Facility | 52 | $916.61 | $1,006.09 | $1,463.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,573.95 / $8,593.09 / $14,433.40
| Facility | | $3,573.95 | $8,593.09 | $14,433.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $680.00 / $870.49 / $2,054.82
| Facility | | $680.00 | $870.49 | $2,054.82 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $1,615.65 / $1,615.65 / $1,615.65
| Facility | 52 | $1,615.65 | $1,615.65 | $1,615.65 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $201.96 / $201.96 / $201.96
| Facility | AS | $201.96 | $201.96 | $201.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $718.00 / $2,575.00 / $7,326.50
| Facility | | $718.00 | $2,575.00 | $7,326.50 |