- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,400.00 / $1,852.13 / $2,803.66
| Facility | | $1,400.00 | $1,852.13 | $2,803.66 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $926.07 / $926.07 / $1,401.83
| Facility | 52 | $926.07 | $926.07 | $1,401.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,912.42 / $2,171.23 / $2,365.59
| Facility | | $1,912.42 | $2,171.23 | $2,365.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,054.82 / $2,054.82 / $2,054.82
| Facility | | $2,054.82 | $2,054.82 | $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 |