- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,267.26 / $1,267.26 / $1,933.12
| Facility | | $1,267.26 | $1,267.26 | $1,933.12 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $633.63 / $633.63 / $966.56
| Facility | 52 | $633.63 | $633.63 | $966.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.25 / $1,497.06 / $1,631.07
| Facility | | $1,318.25 | $1,497.06 | $1,631.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,411.74 / $1,411.74 / $1,411.74
| Facility | | $1,411.74 | $1,411.74 | $1,411.74 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $1,108.61 / $1,108.61 / $1,108.61
| Facility | 52 | $1,108.61 | $1,108.61 | $1,108.61 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $138.58 / $138.58 / $138.58
| Facility | AS | $138.58 | $138.58 | $138.58 |