- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $7,943.28 / $13,182.57
| Facility | | $2,454.71 | $7,943.28 | $13,182.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,709.64 / $11,220.18 / $21,877.62
| Facility | | $8,709.64 | $11,220.18 | $21,877.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $3,981.07 / $19,054.61
| Facility | | $1,096.48 | $3,981.07 | $19,054.61 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $16,982.44 / $16,982.44 / $16,982.44
| Facility | 52 | $16,982.44 | $16,982.44 | $16,982.44 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $13,182.57 / $13,182.57 / $13,182.57
| Facility | 62 | $13,182.57 | $13,182.57 | $13,182.57 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $2,089.30 / $2,089.30 / $2,089.30
| Facility | AS | $2,089.30 | $2,089.30 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,630.27 / $3,388.44 / $4,365.16
| Professional | | $2,630.27 | $3,388.44 | $4,365.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,511.38 / $10,000.00 / $16,218.10
| Facility | | $8,511.38 | $10,000.00 | $16,218.10 |