- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,630.83 / $5,086.18 / $11,352.03
| Facility | | $1,630.83 | $5,086.18 | $11,352.03 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $4,126.00 / $8,074.60 / $9,680.25
| Facility | 50 | $4,126.00 | $8,074.60 | $9,680.25 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $715.48 / $744.10 / $1,113.56
| Facility | 52 | $715.48 | $744.10 | $1,113.56 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $5,967.75 / $5,967.75 / $5,967.75
| Facility | 62 | $5,967.75 | $5,967.75 | $5,967.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,443.89 / $12,333.00 / $23,008.27
| Facility | | $6,443.89 | $12,333.00 | $23,008.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,650.42 / $1,650.42 / $2,292.48
| Facility | | $1,650.42 | $1,650.42 | $2,292.48 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $1,300.40 / $1,300.40 / $1,300.40
| Facility | 52 | $1,300.40 | $1,300.40 | $1,300.40 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $1,015.94 / $1,015.94 / $1,015.94
| Facility | 62 | $1,015.94 | $1,015.94 | $1,015.94 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $162.55 / $162.55 / $162.55
| Facility | AS | $162.55 | $162.55 | $162.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,981.00 / $3,951.00 / $7,934.00
| Facility | | $1,981.00 | $3,951.00 | $7,934.00 |