- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $3,162.28 / $6,456.54
| Facility | | $1,288.25 | $3,162.28 | $6,456.54 |
- 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 / $19,054.61 / $19,054.61
| Facility | | $54.95 | $19,054.61 | $19,054.61 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $15,135.61 / $15,135.61 / $15,135.61
| Facility | 52 | $15,135.61 | $15,135.61 | $15,135.61 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $1,905.46 / $1,905.46 / $1,905.46
| Facility | AS | $1,905.46 | $1,905.46 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,456.54 / $13,182.57 / $27,542.29
| Facility | | $6,456.54 | $13,182.57 | $27,542.29 |