- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,114.68 / $9,448.87 / $27,174.46
| Facility | | $4,114.68 | $9,448.87 | $27,174.46 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $367.78 / $367.78 / $562.67
| Facility | 52 | $367.78 | $367.78 | $562.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $703.35 / $844.02 / $1,068.32
| Facility | | $703.35 | $844.02 | $1,068.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $818.95 / $818.95 / $818.95
| Facility | | $818.95 | $818.95 | $818.95 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $645.72 / $645.72 / $645.72
| Facility | 52 | $645.72 | $645.72 | $645.72 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $80.72 / $80.72 / $80.72
| Facility | AS | $80.72 | $80.72 | $80.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,144.10 / $23,455.08 / $28,006.31
| Facility | | $7,144.10 | $23,455.08 | $28,006.31 |