- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,075.10 / $4,737.12 / $16,467.00
| Facility | | $2,075.10 | $4,737.12 | $16,467.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $1,037.55 / $2,368.56 / $2,368.56
| Facility | 52 | $1,037.55 | $2,368.56 | $2,368.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $560.00 / $615.00
| Facility | | $100.00 | $560.00 | $615.00 |
- 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
- $1,587.93 / $2,075.10 / $3,547.13
| Facility | | $1,587.93 | $2,075.10 | $3,547.13 |
- Facility/Professional
- Facility
- Modifier
- 80
- Low / Median / High Price
- $308.39 / $341.80 / $642.90
| Facility | 80 | $308.39 | $341.80 | $642.90 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $215.88 / $247.72 / $450.03
| Facility | AS | $215.88 | $247.72 | $450.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $454.00 / $6,074.00 / $8,818.00
| Facility | | $454.00 | $6,074.00 | $8,818.00 |