- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,748.30 / $18,748.30 / $18,748.30
| Facility | | $18,748.30 | $18,748.30 | $18,748.30 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $392.21 / $392.21 / $599.46
| Facility | 52 | $392.21 | $392.21 | $599.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $818.34 / $928.46 / $1,011.58
| Facility | | $818.34 | $928.46 | $1,011.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $875.09 / $875.09 / $875.09
| Facility | | $875.09 | $875.09 | $875.09 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $688.97 / $688.97 / $688.97
| Facility | 52 | $688.97 | $688.97 | $688.97 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $86.12 / $86.12 / $86.12
| Facility | AS | $86.12 | $86.12 | $86.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,427.27 / $7,427.27 / $7,427.27
| Facility | | $7,427.27 | $7,427.27 | $7,427.27 |