- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,113.70 / $3,328.55 / $7,879.32
| Facility | | $1,113.70 | $3,328.55 | $7,879.32 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $528.16 / $577.94 / $839.93
| Facility | 52 | $528.16 | $577.94 | $839.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,892.92 / $8,361.59 / $13,917.11
| Facility | | $3,892.92 | $8,361.59 | $13,917.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $680.00 / $870.49 / $1,187.10
| Facility | | $680.00 | $870.49 | $1,187.10 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $931.75 / $931.75 / $931.75
| Facility | 52 | $931.75 | $931.75 | $931.75 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $116.47 / $116.47 / $116.47
| Facility | AS | $116.47 | $116.47 | $116.47 |
- 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 |