- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,114.00 / $6,060.00 / $18,566.00
| Facility | | $2,114.00 | $6,060.00 | $18,566.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,763.75 / $6,855.80 / $10,860.55
| Facility | | $1,763.75 | $6,855.80 | $10,860.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,812.50 / $2,435.77 / $16,841.00
| Facility | | $1,812.50 | $2,435.77 | $16,841.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $3,825.93 / $3,825.93 / $6,958.71
| Facility | 52 | $3,825.93 | $3,825.93 | $6,958.71 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $478.24 / $478.24 / $869.84
| Facility | AS | $478.24 | $478.24 | $869.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,560.00 / $10,420.00 / $22,633.00
| Facility | | $3,560.00 | $10,420.00 | $22,633.00 |