- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,400.00 / $1,878.70 / $2,856.43
| Facility | | $1,400.00 | $1,878.70 | $2,856.43 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $939.35 / $939.35 / $1,428.22
| Facility | 52 | $939.35 | $939.35 | $1,428.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,954.38 / $2,212.10 / $2,410.11
| Facility | | $1,954.38 | $2,212.10 | $2,410.11 |
- 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
- $765.00 / $765.00 / $765.00
| Facility | | $765.00 | $765.00 | $765.00 |