- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $10,232.93 / $19,952.62
| Facility | | $1,737.80 | $10,232.93 | $19,952.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.76 / $20,892.96 / $35,481.34
| Facility | | $2,187.76 | $20,892.96 | $35,481.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $891.25 / $2,570.40
| Facility | | $891.25 | $891.25 | $2,570.40 |
- 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
- Professional
- Modifier
- Low / Median / High Price
- $2,630.27 / $2,630.27 / $3,467.37
| Professional | | $2,630.27 | $2,630.27 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.11 / $2,089.30 / $3,548.13
| Facility | | $1,479.11 | $2,089.30 | $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 |