- 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
- $781.71 / $781.71 / $781.71
| Facility | 52 | $781.71 | $781.71 | $781.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,218.81 / $10,465.26 / $18,365.84
| Facility | | $7,218.81 | $10,465.26 | $18,365.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,563.42 / $2,642.18 / $3,748.52
| Facility | | $1,563.42 | $2,642.18 | $3,748.52 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $6,402.84 / $6,402.84 / $6,402.84
| Facility | 52 | $6,402.84 | $6,402.84 | $6,402.84 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $800.36 / $800.36 / $800.36
| Facility | AS | $800.36 | $800.36 | $800.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,699.00 / $3,847.86 / $5,204.66
| Facility | | $2,699.00 | $3,847.86 | $5,204.66 |
- 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 |