- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $7,943.28 / $16,595.87
| Facility | | $2,089.30 | $7,943.28 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $562.34 / $3,019.95
| Facility | | $34.67 | $562.34 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $3,630.78 / $3,630.78 / $3,630.78
| Facility | 22 | $3,630.78 | $3,630.78 | $3,630.78 |
- 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
- $302.00 / $302.00 / $302.00
| Facility | AS | $302.00 | $302.00 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,862.09 / $1,862.09 / $2,238.72
| Professional | | $1,862.09 | $1,862.09 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $2,238.72 / $3,715.35
| Facility | | $1,621.81 | $2,238.72 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $478.63 / $6,165.95 / $8,912.51
| Facility | | $478.63 | $6,165.95 | $8,912.51 |