- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,191.42 / $2,747.00 / $4,806.64
| Facility | | $1,191.42 | $2,747.00 | $4,806.64 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $595.71 / $595.71 / $595.71
| Facility | 52 | $595.71 | $595.71 | $595.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,733.00 / $11,194.88
| Facility | | $55.00 | $2,733.00 | $11,194.88 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $2,456.48 / $4,797.46 / $4,797.46
| Facility | 52 | $2,456.48 | $4,797.46 | $4,797.46 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $307.06 / $599.67 / $599.67
| Facility | AS | $307.06 | $599.67 | $599.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.00 / $680.00 / $748.00
| Facility | | $50.00 | $680.00 | $748.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $1,914.53 / $6,679.00
| Facility | | $300.00 | $1,914.53 | $6,679.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,446.00 / $11,194.88
| Facility | | $55.00 | $2,446.00 | $11,194.88 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $2,456.48 / $4,797.46 / $4,797.46
| Facility | 52 | $2,456.48 | $4,797.46 | $4,797.46 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $307.06 / $599.67 / $599.67
| Facility | AS | $307.06 | $599.67 | $599.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $789.00 / $2,446.00 / $4,050.00
| Facility | | $789.00 | $2,446.00 | $4,050.00 |