- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $4,073.80 / $10,000.00
| Facility | | $616.60 | $4,073.80 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $338.84 / $630.96 / $1,023.29
| Facility | | $338.84 | $630.96 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $269.15 / $269.15 / $269.15
| Facility | 52 | $269.15 | $269.15 | $269.15 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $67.61 / $67.61 / $67.61
| Facility | 53 | $67.61 | $67.61 | $67.61 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $208.93 / $208.93 / $208.93
| Facility | 62 | $208.93 | $208.93 | $208.93 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $33.88 / $33.88 / $33.88
| Facility | AS | $33.88 | $33.88 | $33.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,090.30 / $5,754.40 / $11,481.54
| Facility | | $3,090.30 | $5,754.40 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $3,311.31 / $6,606.93
| Facility | | $707.95 | $3,311.31 | $6,606.93 |