- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,324.07 / $6,086.00 / $12,444.00
| Facility | | $1,324.07 | $6,086.00 | $12,444.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $642.33 / $680.35 / $749.41
| Facility | 52 | $642.33 | $680.35 | $749.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $400.00 / $510.00 / $6,763.00
| Facility | | $400.00 | $510.00 | $6,763.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $1,366.02 / $1,366.02 / $1,366.02
| Facility | 52 | $1,366.02 | $1,366.02 | $1,366.02 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $170.75 / $170.75 / $170.75
| Facility | AS | $170.75 | $170.75 | $170.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,600.00 / $19,859.00 / $31,911.00
| Facility | | $6,600.00 | $19,859.00 | $31,911.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,731.00 / $10,254.00 / $15,888.00
| Facility | | $2,731.00 | $10,254.00 | $15,888.00 |