- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $900.00 / $2,781.00 / $5,432.00
| Facility | | $900.00 | $2,781.00 | $5,432.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $1,101.31 / $1,133.66 / $1,262.30
| Facility | 52 | $1,101.31 | $1,133.66 | $1,262.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,132.82 / $7,564.81 / $10,923.70
| Facility | | $4,132.82 | $7,564.81 | $10,923.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,383.33 / $2,094.96 / $2,094.96
| Facility | | $1,383.33 | $2,094.96 | $2,094.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $488.00 / $675.00 / $1,742.51
| Facility | | $488.00 | $675.00 | $1,742.51 |
- 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
- $1,141.00 / $4,717.00 / $10,959.00
| Facility | | $1,141.00 | $4,717.00 | $10,959.00 |