- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,760.00 / $4,261.00 / $12,154.00
| Facility | | $1,760.00 | $4,261.00 | $12,154.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $811.98 / $811.98 / $1,060.09
| Facility | 52 | $811.98 | $811.98 | $1,060.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,234.00 / $4,319.00 / $10,043.00
| Facility | | $2,234.00 | $4,319.00 | $10,043.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,530.00 / $2,530.00 / $2,530.00
| Facility | | $2,530.00 | $2,530.00 | $2,530.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.56 / $2,273.88 / $4,802.84
| Facility | | $1,445.56 | $2,273.88 | $4,802.84 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $3,473.16 / $6,402.84 / $6,402.84
| Facility | 52 | $3,473.16 | $6,402.84 | $6,402.84 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $434.15 / $800.36 / $800.36
| Facility | AS | $434.15 | $800.36 | $800.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,189.00 / $3,300.00 / $11,186.00
| Facility | | $1,189.00 | $3,300.00 | $11,186.00 |