- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $363.08 / $4,570.88 / $11,481.54
| Facility | | $363.08 | $4,570.88 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,818.38 / $6,606.93 / $13,803.84
| Facility | | $2,818.38 | $6,606.93 | $13,803.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $257.04 / $501.19 / $1,621.81
| Facility | | $257.04 | $501.19 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $323.59 / $323.59 / $323.59
| Facility | 52 | $323.59 | $323.59 | $323.59 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $40.74 / $40.74 / $40.74
| Facility | AS | $40.74 | $40.74 | $40.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $2,818.38 / $9,772.37
| Facility | | $524.81 | $2,818.38 | $9,772.37 |