- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $4,786.30 / $12,022.64
| Facility | | $1,122.02 | $4,786.30 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $8,709.64 / $16,218.10
| Facility | | $3,235.94 | $8,709.64 | $16,218.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $1,318.26 / $3,548.13
| Facility | | $398.11 | $1,318.26 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $1,584.89 / $1,584.89 / $1,584.89
| Facility | 22 | $1,584.89 | $1,584.89 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $1,047.13 / $1,047.13 / $1,047.13
| Facility | 52 | $1,047.13 | $1,047.13 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $131.83 / $131.83 / $131.83
| Facility | AS | $131.83 | $131.83 | $131.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $4,677.35 / $11,481.54
| Facility | | $1,318.26 | $4,677.35 | $11,481.54 |