- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,823.98 / $3,772.57 / $7,879.32
| Facility | | $1,823.98 | $3,772.57 | $7,879.32 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $932.77 / $1,026.00 / $1,495.78
| Facility | 52 | $932.77 | $1,026.00 | $1,495.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,671.00 / $9,122.94 / $14,433.40
| Facility | | $3,671.00 | $9,122.94 | $14,433.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $680.00 / $870.49 / $2,094.52
| Facility | | $680.00 | $870.49 | $2,094.52 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $1,648.76 / $1,648.76 / $1,648.76
| Facility | 52 | $1,648.76 | $1,648.76 | $1,648.76 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $206.10 / $206.10 / $206.10
| Facility | AS | $206.10 | $206.10 | $206.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $781.00 / $2,697.00 / $6,819.50
| Facility | | $781.00 | $2,697.00 | $6,819.50 |