- 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
- $683.45 / $683.45 / $683.45
| Facility | 52 | $683.45 | $683.45 | $683.45 |
- 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
- $1,366.90 / $2,320.71 / $3,376.01
| Facility | | $1,366.90 | $2,320.71 | $3,376.01 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $5,570.85 / $5,570.85 / $5,570.85
| Facility | 52 | $5,570.85 | $5,570.85 | $5,570.85 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $696.36 / $696.36 / $696.36
| Facility | AS | $696.36 | $696.36 | $696.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,491.00 / $3,347.87 / $4,750.10
| Facility | | $2,491.00 | $3,347.87 | $4,750.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,178.00 / $7,441.00 / $8,816.00
| Facility | | $6,178.00 | $7,441.00 | $8,816.00 |