- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,981.07 / $11,481.54 / $19,952.62
| Facility | | $3,981.07 | $11,481.54 | $19,952.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.83 / $20,892.96 / $35,481.34
| Facility | | $2,398.83 | $20,892.96 | $35,481.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $891.25 / $2,511.89
| Facility | | $891.25 | $891.25 | $2,511.89 |
- 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
- Professional
- Modifier
- Low / Median / High Price
- $2,511.89 / $2,511.89 / $3,388.44
| Professional | | $2,511.89 | $2,511.89 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $1,995.26 / $3,548.13
| Facility | | $1,445.44 | $1,995.26 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,317.64 / $22,387.21 / $41,686.94
| Facility | | $8,317.64 | $22,387.21 | $41,686.94 |