- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.00 / $4,110.60 / $20,647.00
| Facility | | $1,995.00 | $4,110.60 | $20,647.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $702.16 / $1,043.01 / $2,006.67
| Facility | 52 | $702.16 | $1,043.01 | $2,006.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,512.00 / $7,194.00 / $13,623.00
| Facility | | $3,512.00 | $7,194.00 | $13,623.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,800.00 / $22,189.40 / $22,189.40
| Facility | | $2,800.00 | $22,189.40 | $22,189.40 |
- 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
- $5,052.00 / $10,886.00 / $20,054.00
| Facility | | $5,052.00 | $10,886.00 | $20,054.00 |