- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $633.02 / $1,628.32 / $5,425.60
| Facility | | $633.02 | $1,628.32 | $5,425.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $225.67 / $225.67 / $611.00
| Facility | | $225.67 | $225.67 | $611.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $176.57 / $176.57 / $176.57
| Facility | 52 | $176.57 | $176.57 | $176.57 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $44.14 / $44.14 / $44.14
| Facility | 53 | $44.14 | $44.14 | $44.14 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $137.94 / $137.94 / $137.94
| Facility | 62 | $137.94 | $137.94 | $137.94 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $22.07 / $22.07 / $22.07
| Facility | AS | $22.07 | $22.07 | $22.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $633.02 / $3,925.37 / $8,324.51
| Facility | | $633.02 | $3,925.37 | $8,324.51 |