- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,603.36 / $5,560.00 / $12,748.00
| Facility | | $1,603.36 | $5,560.00 | $12,748.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $705.94 / $801.69 / $6,833.64
| Facility | 52 | $705.94 | $801.69 | $6,833.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,234.00 / $4,358.00 / $12,235.48
| Facility | | $2,234.00 | $4,358.00 | $12,235.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,530.00 / $10,806.00 / $10,806.00
| Facility | | $2,530.00 | $10,806.00 | $10,806.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,411.87 / $2,307.25 / $5,246.00
| Facility | | $1,411.87 | $2,307.25 | $5,246.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $3,037.26 / $5,570.85 / $5,570.85
| Facility | 52 | $3,037.26 | $5,570.85 | $5,570.85 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $379.66 / $696.36 / $696.36
| Facility | AS | $379.66 | $696.36 | $696.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,285.00 / $4,000.00 / $9,817.00
| Facility | | $2,285.00 | $4,000.00 | $9,817.00 |