- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,646.58 / $3,772.57 / $7,879.32
| Facility | | $1,646.58 | $3,772.57 | $7,879.32 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $831.27 / $913.31 / $1,332.33
| Facility | 52 | $831.27 | $913.31 | $1,332.33 |
- 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 / $1,873.50
| Facility | | $680.00 | $870.49 | $1,873.50 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $1,468.02 / $1,468.02 / $1,468.02
| Facility | 52 | $1,468.02 | $1,468.02 | $1,468.02 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $183.50 / $183.50 / $183.50
| Facility | AS | $183.50 | $183.50 | $183.50 |
- 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 |