- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,506.00 / $3,149.00 / $10,651.00
| Facility | | $2,506.00 | $3,149.00 | $10,651.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $822.53 / $822.53 / $822.53
| Facility | 52 | $822.53 | $822.53 | $822.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,586.00 / $7,613.00 / $13,400.83
| Facility | | $4,586.00 | $7,613.00 | $13,400.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $800.00 / $1,873.50 / $2,530.00
| Facility | | $800.00 | $1,873.50 | $2,530.00 |
- 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
- $1,645.06 / $2,122.17 / $2,795.00
| Facility | | $1,645.06 | $2,122.17 | $2,795.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,916.57 / $2,395.71 / $3,353.99
| Professional | | $1,916.57 | $2,395.71 | $3,353.99 |
- Facility/Professional
- Professional
- Modifier
- 80
- Low / Median / High Price
- $51.11 / $51.11 / $51.11
| Professional | 80 | $51.11 | $51.11 | $51.11 |
- Facility/Professional
- Professional
- Modifier
- AS
- Low / Median / High Price
- $43.44 / $43.44 / $43.44
| Professional | AS | $43.44 | $43.44 | $43.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,115.00 / $5,540.00 / $12,740.00
| Facility | | $1,115.00 | $5,540.00 | $12,740.00 |