- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,911.99 / $37,426.10 / $37,426.10
| Facility | | $1,911.99 | $37,426.10 | $37,426.10 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $869.09 / $869.09 / $1,346.31
| Facility | 52 | $869.09 | $869.09 | $1,346.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,856.41 / $2,085.25 / $2,271.90
| Facility | | $1,856.41 | $2,085.25 | $2,271.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,984.25 / $1,984.25 / $1,984.25
| Facility | | $1,984.25 | $1,984.25 | $1,984.25 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $1,569.13 / $1,569.13 / $1,569.13
| Facility | 52 | $1,569.13 | $1,569.13 | $1,569.13 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $196.14 / $196.14 / $196.14
| Facility | AS | $196.14 | $196.14 | $196.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,052.04 / $11,052.04 / $57,676.35
| Facility | | $11,052.04 | $11,052.04 | $57,676.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,421.00 / $8,421.00 / $8,421.00
| Facility | | $8,421.00 | $8,421.00 | $8,421.00 |