- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,356.30 / $7,704.00 / $13,516.00
| Facility | | $2,356.30 | $7,704.00 | $13,516.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $943.32 / $943.32 / $943.32
| Facility | 52 | $943.32 | $943.32 | $943.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,713.00 / $26,117.75 / $49,288.00
| Facility | | $13,713.00 | $26,117.75 | $49,288.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,886.64 / $2,540.71 / $3,395.95
| Facility | | $1,886.64 | $2,540.71 | $3,395.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,054.76 / $2,727.22 / $4,202.91
| Professional | | $2,054.76 | $2,727.22 | $4,202.91 |
- Facility/Professional
- Professional
- Modifier
- 80
- Low / Median / High Price
- $59.77 / $59.77 / $59.77
| Professional | 80 | $59.77 | $59.77 | $59.77 |
- Facility/Professional
- Professional
- Modifier
- AS
- Low / Median / High Price
- $50.81 / $50.81 / $50.81
| Professional | AS | $50.81 | $50.81 | $50.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,858.00 / $21,238.00 / $30,333.00
| Facility | | $12,858.00 | $21,238.00 | $30,333.00 |