- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,100.00 / $4,840.00 / $14,853.00
| Facility | | $2,100.00 | $4,840.00 | $14,853.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $944.35 / $3,555.20 / $5,814.97
| Facility | | $944.35 | $3,555.20 | $5,814.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,530.69 / $2,084.65 / $16,451.27
| Facility | | $1,530.69 | $2,084.65 | $16,451.27 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $3,251.39 / $3,251.39 / $38,006.16
| Facility | 52 | $3,251.39 | $3,251.39 | $38,006.16 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $406.42 / $406.42 / $4,750.77
| Facility | AS | $406.42 | $406.42 | $4,750.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,101.00 / $8,399.00 / $16,987.00
| Facility | | $5,101.00 | $8,399.00 | $16,987.00 |