- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $7,943.28 / $14,454.40
| Facility | | $5,011.87 | $7,943.28 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,882.50 / $16,982.44 / $33,113.11
| Facility | | $12,882.50 | $16,982.44 | $33,113.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,125.38 / $14,125.38 / $14,125.38
| Facility | | $14,125.38 | $14,125.38 | $14,125.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $2,630.27 / $19,054.61
| Facility | | $1,445.44 | $2,630.27 | $19,054.61 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $3,235.94 / $38,018.94 / $38,018.94
| Facility | 52 | $3,235.94 | $38,018.94 | $38,018.94 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $407.38 / $4,786.30 / $4,786.30
| Facility | AS | $407.38 | $4,786.30 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,019.95 / $3,715.35 / $5,011.87
| Professional | | $3,019.95 | $3,715.35 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,125.38 / $14,125.38 / $14,125.38
| Facility | | $14,125.38 | $14,125.38 | $14,125.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,309.57 / $8,912.51 / $16,982.44
| Facility | | $6,309.57 | $8,912.51 | $16,982.44 |