- 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
- $825.22 / $825.22 / $825.22
| Facility | 52 | $825.22 | $825.22 | $825.22 |
- 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
- $1,650.43 / $2,805.73 / $3,976.52
| Facility | | $1,650.43 | $2,805.73 | $3,976.52 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $6,724.98 / $6,724.98 / $6,724.98
| Facility | 52 | $6,724.98 | $6,724.98 | $6,724.98 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $840.62 / $840.62 / $840.62
| Facility | AS | $840.62 | $840.62 | $840.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.00 / $4,041.45 / $5,505.03
| Facility | | $2,884.00 | $4,041.45 | $5,505.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,126.00 / $4,317.00 / $7,856.00
| Facility | | $3,126.00 | $4,317.00 | $7,856.00 |