- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,564.75 / $21,631.68 / $21,631.68
| Facility | | $1,564.75 | $21,631.68 | $21,631.68 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $782.38 / $782.38 / $1,189.30
| Facility | 52 | $782.38 | $782.38 | $1,189.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,625.57 / $1,842.04 / $2,006.94
| Facility | | $1,625.57 | $1,842.04 | $2,006.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,742.51 / $1,742.51 / $1,742.51
| Facility | | $1,742.51 | $1,742.51 | $1,742.51 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $1,366.02 / $1,366.02 / $1,366.02
| Facility | 52 | $1,366.02 | $1,366.02 | $1,366.02 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $170.75 / $170.75 / $170.75
| Facility | AS | $170.75 | $170.75 | $170.75 |