- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,068.40 / $1,068.40 / $1,630.02
| Facility | | $1,068.40 | $1,068.40 | $1,630.02 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $534.20 / $534.20 / $815.01
| Facility | 52 | $534.20 | $534.20 | $815.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,108.89 / $1,262.33 / $1,375.33
| Facility | | $1,108.89 | $1,262.33 | $1,375.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,187.10 / $1,187.10 / $1,187.10
| Facility | | $1,187.10 | $1,187.10 | $1,187.10 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $931.75 / $931.75 / $931.75
| Facility | 52 | $931.75 | $931.75 | $931.75 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $116.47 / $116.47 / $116.47
| Facility | AS | $116.47 | $116.47 | $116.47 |