- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,194.61 / $7,270.54 / $17,000.00
| Facility | | $2,194.61 | $7,270.54 | $17,000.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $604.89 / $604.89 / $731.54
| Facility | 52 | $604.89 | $604.89 | $731.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,114.00 / $4,762.00 / $14,298.00
| Facility | | $2,114.00 | $4,762.00 | $14,298.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,806.00 / $10,806.00 / $27,150.00
| Facility | | $10,806.00 | $10,806.00 | $27,150.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,295.47 / $2,702.62 / $19,082.00
| Facility | | $1,295.47 | $2,702.62 | $19,082.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $2,442.64 / $16,840.24 / $16,840.24
| Facility | 52 | $2,442.64 | $16,840.24 | $16,840.24 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $1,908.31 / $13,156.44 / $13,156.44
| Facility | 62 | $1,908.31 | $13,156.44 | $13,156.44 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $305.33 / $2,105.03 / $2,105.03
| Facility | AS | $305.33 | $2,105.03 | $2,105.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,578.00 / $7,900.00 / $19,082.00
| Facility | | $2,578.00 | $7,900.00 | $19,082.00 |