- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $1,737.80 / $2,398.83
| Facility | | $776.25 | $1,737.80 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,882.50 / $15,135.61 / $20,417.38
| Facility | | $12,882.50 | $15,135.61 | $20,417.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.83 / $11,748.98 / $11,748.98
| Facility | | $2,398.83 | $11,748.98 | $11,748.98 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $2,884.03 / $2,884.03 / $2,884.03
| Facility | 22 | $2,884.03 | $2,884.03 | $2,884.03 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $1,905.46 / $1,905.46 / $1,905.46
| Facility | 52 | $1,905.46 | $1,905.46 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $239.88 / $239.88 / $239.88
| Facility | AS | $239.88 | $239.88 | $239.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $6,456.54 / $12,022.64
| Facility | | $2,511.89 | $6,456.54 | $12,022.64 |