- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,272.13 / $3,695.07 / $8,130.00
| Facility | | $1,272.13 | $3,695.07 | $8,130.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $627.73 / $685.91 / $998.67
| Facility | 52 | $627.73 | $685.91 | $998.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,573.95 / $8,593.09 / $14,145.76
| Facility | | $3,573.95 | $8,593.09 | $14,145.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $680.00 / $870.49 / $1,411.74
| Facility | | $680.00 | $870.49 | $1,411.74 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $1,108.61 / $1,108.61 / $1,108.61
| Facility | 52 | $1,108.61 | $1,108.61 | $1,108.61 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $138.58 / $138.58 / $138.58
| Facility | AS | $138.58 | $138.58 | $138.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $718.00 / $2,575.00 / $7,326.50
| Facility | | $718.00 | $2,575.00 | $7,326.50 |