- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $6,606.93 / $22,908.68
| Facility | | $1,819.70 | $6,606.93 | $22,908.68 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $3,890.45 / $10,000.00 / $41,686.94
| Facility | 52 | $3,890.45 | $10,000.00 | $41,686.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,265.80 / $12,302.69 / $35,481.34
| Facility | | $4,265.80 | $12,302.69 | $35,481.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $4,365.16 / $14,791.08
| Facility | | $512.86 | $4,365.16 | $14,791.08 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $3,548.13 / $3,548.13 / $3,548.13
| Facility | 22 | $3,548.13 | $3,548.13 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $2,398.83 / $2,398.83 / $2,398.83
| Facility | 52 | $2,398.83 | $2,398.83 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $295.12 / $295.12 / $295.12
| Facility | AS | $295.12 | $295.12 | $295.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $12,589.25 / $34,673.69
| Facility | | $3,630.78 | $12,589.25 | $34,673.69 |