- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,750.92 / $3,772.57 / $7,879.32
| Facility | | $1,750.92 | $3,772.57 | $7,879.32 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $889.74 / $975.88 / $1,422.02
| Facility | 52 | $889.74 | $975.88 | $1,422.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,671.00 / $8,947.00 / $14,433.40
| Facility | | $3,671.00 | $8,947.00 | $14,433.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $680.00 / $870.49 / $2,001.71
| Facility | | $680.00 | $870.49 | $2,001.71 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $1,570.62 / $1,570.62 / $1,570.62
| Facility | 52 | $1,570.62 | $1,570.62 | $1,570.62 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $196.33 / $196.33 / $196.33
| Facility | AS | $196.33 | $196.33 | $196.33 |
- 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 |