- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,300.00 / $51,173.65 / $51,173.65
| Facility | | $2,300.00 | $51,173.65 | $51,173.65 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $716.80 / $716.80 / $716.80
| Facility | 52 | $716.80 | $716.80 | $716.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,428.04 / $1,538.43 / $1,867.04
| Facility | | $1,428.04 | $1,538.43 | $1,867.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,650.42 / $1,650.42 / $1,650.42
| Facility | | $1,650.42 | $1,650.42 | $1,650.42 |
- 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
- $12,185.42 / $16,915.66 / $78,634.27
| Facility | | $12,185.42 | $16,915.66 | $78,634.27 |