- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,254.88 / $4,340.50 / $8,561.00
| Facility | | $1,254.88 | $4,340.50 | $8,561.00 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $9,047.00 / $9,047.00 / $9,047.00
| Facility | 22 | $9,047.00 | $9,047.00 | $9,047.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $543.24 / $591.84 / $858.78
| Facility | 52 | $543.24 | $591.84 | $858.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,892.92 / $8,109.09 / $13,349.38
| Facility | | $3,892.92 | $8,109.09 | $13,349.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $680.00 / $800.00 / $1,219.08
| Facility | | $680.00 | $800.00 | $1,219.08 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $959.49 / $959.49 / $959.49
| Facility | 52 | $959.49 | $959.49 | $959.49 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $119.94 / $119.94 / $119.94
| Facility | AS | $119.94 | $119.94 | $119.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,585.50 / $5,203.50 / $11,462.00
| Facility | | $1,585.50 | $5,203.50 | $11,462.00 |