- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $2,630.27 / $6,606.93
| Facility | | $1,000.00 | $2,630.27 | $6,606.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $229.09 / $346.74 / $3,981.07
| Facility | | $229.09 | $346.74 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $870.96 / $870.96 / $870.96
| Facility | 52 | $870.96 | $870.96 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $109.65 / $109.65 / $109.65
| Facility | AS | $109.65 | $109.65 | $109.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.74 / $1,949.84 / $6,165.95
| Facility | | $346.74 | $1,949.84 | $6,165.95 |