- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,722.52 / $4,261.00 / $12,154.00
| Facility | | $1,722.52 | $4,261.00 | $12,154.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $758.36 / $758.36 / $991.43
| Facility | 52 | $758.36 | $758.36 | $991.43 |
- 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
- $1,464.14 / $2,214.00 / $4,501.62
| Facility | | $1,464.14 | $2,214.00 | $4,501.62 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $3,265.50 / $5,982.62 / $5,982.62
| Facility | 52 | $3,265.50 | $5,982.62 | $5,982.62 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $408.19 / $747.83 / $747.83
| Facility | AS | $408.19 | $747.83 | $747.83 |
- 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 |