- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,241.22 / $11,100.08 / $20,928.72
| Facility | | $4,241.22 | $11,100.08 | $20,928.72 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $461.72 / $461.72 / $461.72
| Facility | 52 | $461.72 | $461.72 | $461.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,416.80 / $9,302.56 / $16,325.39
| Facility | | $6,416.80 | $9,302.56 | $16,325.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $923.43 / $1,534.87 / $2,214.15
| Facility | | $923.43 | $1,534.87 | $2,214.15 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $3,805.14 / $3,805.14 / $3,805.14
| Facility | 52 | $3,805.14 | $3,805.14 | $3,805.14 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $475.64 / $475.64 / $475.64
| Facility | AS | $475.64 | $475.64 | $475.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,561.55 / $2,286.73 / $3,073.08
| Facility | | $1,561.55 | $2,286.73 | $3,073.08 |
- 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 |