- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,156.14 / $14,337.51 / $14,337.51
| Facility | | $2,156.14 | $14,337.51 | $14,337.51 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $694.31 / $694.31 / $1,078.07
| Facility | 52 | $694.31 | $694.31 | $1,078.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,488.89 / $1,669.78 / $1,819.25
| Facility | | $1,488.89 | $1,669.78 | $1,819.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,589.74 / $1,589.74 / $1,589.74
| Facility | | $1,589.74 | $1,589.74 | $1,589.74 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $1,259.83 / $1,259.83 / $1,259.83
| Facility | 52 | $1,259.83 | $1,259.83 | $1,259.83 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $157.47 / $157.47 / $157.47
| Facility | AS | $157.47 | $157.47 | $157.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,585.58 / $12,585.58 / $12,585.58
| Facility | | $12,585.58 | $12,585.58 | $12,585.58 |