- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,241.22 / $10,431.19 / $20,928.72
| Facility | | $4,241.22 | $10,431.19 | $20,928.72 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $105.61 / $105.61 / $105.61
| Facility | 52 | $105.61 | $105.61 | $105.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,584.12 / $13,894.28 / $24,383.56
| Facility | | $9,584.12 | $13,894.28 | $24,383.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $211.21 / $369.62 / $568.14
| Facility | | $211.21 | $369.62 | $568.14 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $868.31 / $868.31 / $868.31
| Facility | 52 | $868.31 | $868.31 | $868.31 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $108.54 / $108.54 / $108.54
| Facility | AS | $108.54 | $108.54 | $108.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $410.00 / $521.82 / $742.51
| Facility | | $410.00 | $521.82 | $742.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,054.00 / $4,317.00 / $13,909.00
| Facility | | $3,054.00 | $4,317.00 | $13,909.00 |