- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,365.16 / $10,964.78 / $20,417.38
| Facility | | $4,365.16 | $10,964.78 | $20,417.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,964.78 / $25,118.86 / $47,863.01
| Facility | | $10,964.78 | $25,118.86 | $47,863.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $891.25 / $2,754.23
| Facility | | $891.25 | $891.25 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $3,311.31 / $3,311.31 / $3,311.31
| Facility | 22 | $3,311.31 | $3,311.31 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $2,187.76 / $2,187.76 / $2,187.76
| Facility | 52 | $2,187.76 | $2,187.76 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $275.42 / $275.42 / $275.42
| Facility | AS | $275.42 | $275.42 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,715.35 / $3,715.35 / $3,715.35
| Professional | | $3,715.35 | $3,715.35 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $2,041.74 / $3,388.44
| Facility | | $1,584.89 | $2,041.74 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,309.57 / $16,218.10 / $32,359.37
| Facility | | $6,309.57 | $16,218.10 | $32,359.37 |