- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,241.22 / $10,431.19 / $21,899.37
| Facility | | $4,241.22 | $10,431.19 | $21,899.37 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $785.32 / $785.32 / $785.32
| Facility | 52 | $785.32 | $785.32 | $785.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,999.34 / $17,097.68 / $33,072.44
| Facility | | $12,999.34 | $17,097.68 | $33,072.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,570.64 / $2,748.62 / $8,220.00
| Facility | | $1,570.64 | $2,748.62 | $8,220.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $3,506.64 / $6,354.39 / $6,354.39
| Facility | 52 | $3,506.64 | $6,354.39 | $6,354.39 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $438.33 / $794.30 / $794.30
| Facility | AS | $438.33 | $794.30 | $794.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,042.60 / $3,818.75 / $5,369.54
| Facility | | $2,042.60 | $3,818.75 | $5,369.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,777.00 / $8,220.00 / $9,696.00
| Facility | | $6,777.00 | $8,220.00 | $9,696.00 |