- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $6,025.60 / $18,620.87
| Facility | | $1,737.80 | $6,025.60 | $18,620.87 |
- 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
- $512.86 / $4,677.35 / $15,848.93
| Facility | | $512.86 | $4,677.35 | $15,848.93 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $3,090.30 / $3,090.30 / $3,090.30
| Facility | 22 | $3,090.30 | $3,090.30 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $2,089.30 / $2,089.30 / $2,089.30
| Facility | 52 | $2,089.30 | $2,089.30 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $257.04 / $257.04 / $257.04
| Facility | AS | $257.04 | $257.04 | $257.04 |
- 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 |