- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,400.00 / $1,680.03 / $2,554.21
| Facility | | $1,400.00 | $1,680.03 | $2,554.21 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $840.02 / $840.02 / $1,277.10
| Facility | 52 | $840.02 | $840.02 | $1,277.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,746.58 / $1,978.06 / $2,155.13
| Facility | | $1,746.58 | $1,978.06 | $2,155.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,873.50 / $1,873.50 / $1,873.50
| Facility | | $1,873.50 | $1,873.50 | $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 |