- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,400.00 / $1,800.56 / $2,739.25
| Facility | | $1,400.00 | $1,800.56 | $2,739.25 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $900.28 / $900.28 / $1,369.63
| Facility | 52 | $900.28 | $900.28 | $1,369.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,866.74 / $2,121.35 / $2,311.23
| Facility | | $1,866.74 | $2,121.35 | $2,311.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,001.71 / $2,001.71 / $2,001.71
| Facility | | $2,001.71 | $2,001.71 | $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 |