- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $5,888.44 / $17,378.01
| Facility | | $1,819.70 | $5,888.44 | $17,378.01 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $4,897.79 / $4,897.79 / $4,897.79
| Facility | 22 | $4,897.79 | $4,897.79 | $4,897.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,677.35 / $13,803.84 / $29,512.09
| Facility | | $4,677.35 | $13,803.84 | $29,512.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $5,248.07 / $15,135.61
| Facility | | $398.11 | $5,248.07 | $15,135.61 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $3,548.13 / $3,548.13 / $3,548.13
| Facility | 22 | $3,548.13 | $3,548.13 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $2,344.23 / $2,344.23 / $2,344.23
| Facility | 52 | $2,344.23 | $2,344.23 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $295.12 / $295.12 / $295.12
| Facility | AS | $295.12 | $295.12 | $295.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $8,912.51 / $21,877.62
| Facility | | $2,884.03 | $8,912.51 | $21,877.62 |