- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,091.95 / $3,782.50 / $8,631.64
| Facility | | $1,091.95 | $3,782.50 | $8,631.64 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $443.54 / $494.58 / $660.74
| Facility | 52 | $443.54 | $494.58 | $660.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,989.00 / $10,467.00 / $26,317.00
| Facility | | $4,989.00 | $10,467.00 | $26,317.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,061.80 / $17,222.00 / $17,860.98
| Facility | | $17,061.80 | $17,222.00 | $17,860.98 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $769.80 / $769.80 / $769.80
| Facility | 52 | $769.80 | $769.80 | $769.80 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $96.23 / $96.23 / $96.23
| Facility | AS | $96.23 | $96.23 | $96.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,685.00 / $12,457.00 / $26,782.00
| Facility | | $4,685.00 | $12,457.00 | $26,782.00 |