- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,671.00 / $4,474.00 / $7,960.15
| Facility | | $1,671.00 | $4,474.00 | $7,960.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,660.00 / $6,198.03 / $10,860.55
| Facility | | $1,660.00 | $6,198.03 | $10,860.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $815.21 / $1,148.66 / $2,372.73
| Facility | | $815.21 | $1,148.66 | $2,372.73 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $2,057.69 / $3,805.14 / $3,805.14
| Facility | 52 | $2,057.69 | $3,805.14 | $3,805.14 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $257.20 / $475.64 / $475.64
| Facility | AS | $257.20 | $475.64 | $475.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $175.00 / $2,572.00 / $14,572.00
| Facility | | $175.00 | $2,572.00 | $14,572.00 |