- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $6,456.54 / $30,199.52
| Facility | | $1,288.25 | $6,456.54 | $30,199.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $10,000.00 / $11,481.54
| Facility | | $34.67 | $10,000.00 | $11,481.54 |
- 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
- $9,332.54 / $20,892.96 / $33,113.11
| Facility | | $9,332.54 | $20,892.96 | $33,113.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,165.95 / $16,982.44 / $43,651.58
| Facility | | $6,165.95 | $16,982.44 | $43,651.58 |