- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $3,715.35 / $7,413.10
| Facility | | $1,659.59 | $3,715.35 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $8,128.31 / $13,489.63
| Facility | | $2,454.71 | $8,128.31 | $13,489.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.20 / $30.20 / $30.20
| Facility | | $30.20 | $30.20 | $30.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $54.95 / $18,197.01 / $18,197.01
| Facility | | $54.95 | $18,197.01 | $18,197.01 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $14,791.08 / $14,791.08 / $14,791.08
| Facility | 52 | $14,791.08 | $14,791.08 | $14,791.08 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $1,819.70 / $1,819.70 / $1,819.70
| Facility | AS | $1,819.70 | $1,819.70 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,456.54 / $11,748.98 / $25,703.96
| Facility | | $6,456.54 | $11,748.98 | $25,703.96 |