- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $1,905.46 / $5,888.44
| Facility | | $1,258.93 | $1,905.46 | $5,888.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,882.50 / $15,135.61 / $20,417.38
| Facility | | $12,882.50 | $15,135.61 | $20,417.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $14,125.38 / $14,125.38
| Facility | | $3,235.94 | $14,125.38 | $14,125.38 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $3,890.45 / $3,890.45 / $3,890.45
| Facility | 22 | $3,890.45 | $3,890.45 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $2,570.40 / $2,570.40 / $2,570.40
| Facility | 52 | $2,570.40 | $2,570.40 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $323.59 / $323.59 / $323.59
| Facility | AS | $323.59 | $323.59 | $323.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $6,606.93 / $12,589.25
| Facility | | $2,511.89 | $6,606.93 | $12,589.25 |