- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,751.66 / $1,873.48 / $8,229.00
| Facility | | $1,751.66 | $1,873.48 | $8,229.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $875.83 / $888.58 / $1,134.92
| Facility | 52 | $875.83 | $888.58 | $1,134.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,049.25 / $9,122.94 / $15,243.15
| Facility | | $5,049.25 | $9,122.94 | $15,243.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.23 / $2,384.42 / $2,750.61
| Facility | | $1,737.23 | $2,384.42 | $2,750.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,094.52 / $2,094.52 / $2,094.52
| Facility | | $2,094.52 | $2,094.52 | $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
- $405.00 / $2,513.00 / $27,879.00
| Facility | | $405.00 | $2,513.00 | $27,879.00 |