- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $6,309.57 / $16,595.87
| Facility | | $2,238.72 | $6,309.57 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $5,370.32 / $7,943.28
| Facility | | $1,659.59 | $5,370.32 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $2,041.74 / $16,595.87
| Facility | | $1,412.54 | $2,041.74 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $2,951.21 / $2,951.21 / $5,370.32
| Facility | 52 | $2,951.21 | $2,951.21 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $371.54 / $371.54 / $676.08
| Facility | AS | $371.54 | $371.54 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $9,772.37 / $18,620.87
| Facility | | $4,570.88 | $9,772.37 | $18,620.87 |