- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,930.08 / $34,858.96 / $34,858.96
| Facility | | $2,930.08 | $34,858.96 | $34,858.96 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $947.12 / $947.12 / $1,465.04
| Facility | 52 | $947.12 | $947.12 | $1,465.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,016.94 / $2,269.14 / $2,472.26
| Facility | | $2,016.94 | $2,269.14 | $2,472.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.96 / $2,155.96 / $2,155.96
| Facility | | $2,155.96 | $2,155.96 | $2,155.96 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $1,701.26 / $1,701.26 / $1,701.26
| Facility | 52 | $1,701.26 | $1,701.26 | $1,701.26 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $212.66 / $212.66 / $212.66
| Facility | AS | $212.66 | $212.66 | $212.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $54,781.19 / $54,781.19 / $54,781.19
| Facility | | $54,781.19 | $54,781.19 | $54,781.19 |