- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $6,025.60 / $18,197.01
| Facility | | $1,698.24 | $6,025.60 | $18,197.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,168.69 / $12,302.69 / $28,183.83
| Facility | | $4,168.69 | $12,302.69 | $28,183.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $3,630.78 / $12,302.69
| Facility | | $645.65 | $3,630.78 | $12,302.69 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $3,019.95 / $3,019.95 / $3,019.95
| Facility | 22 | $3,019.95 | $3,019.95 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $1,995.26 / $1,995.26 / $1,995.26
| Facility | 52 | $1,995.26 | $1,995.26 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $251.19 / $251.19 / $251.19
| Facility | AS | $251.19 | $251.19 | $251.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $12,022.64 / $32,359.37
| Facility | | $3,630.78 | $12,022.64 | $32,359.37 |