- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,602.24 / $5,691.00 / $14,482.00
| Facility | | $1,602.24 | $5,691.00 | $14,482.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $6,578.72 / $6,578.72 / $11,325.00
| Facility | 50 | $6,578.72 | $6,578.72 | $11,325.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $724.25 / $848.63 / $1,541.27
| Facility | 52 | $724.25 | $848.63 | $1,541.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,745.00 / $20,581.00 / $48,414.52
| Facility | | $11,745.00 | $20,581.00 | $48,414.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,589.74 / $1,589.74 / $1,623.15
| Facility | | $1,589.74 | $1,589.74 | $1,623.15 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $1,259.83 / $1,259.83 / $1,259.83
| Facility | 52 | $1,259.83 | $1,259.83 | $1,259.83 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $157.47 / $157.47 / $157.47
| Facility | AS | $157.47 | $157.47 | $157.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,505.00 / $10,504.00 / $24,236.00
| Facility | | $4,505.00 | $10,504.00 | $24,236.00 |