- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,174.90 / $4,466.84 / $11,481.54
| Facility | | $1,174.90 | $4,466.84 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $11,748.98 / $28,840.32
| Facility | | $3,630.78 | $11,748.98 | $28,840.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.11 / $3,019.95 / $16,982.44
| Facility | | $1,479.11 | $3,019.95 | $16,982.44 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $1,778.28 / $1,778.28 / $1,778.28
| Facility | 22 | $1,778.28 | $1,778.28 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $1,174.90 / $1,174.90 / $1,174.90
| Facility | 52 | $1,174.90 | $1,174.90 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $147.91 / $147.91 / $147.91
| Facility | AS | $147.91 | $147.91 | $147.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,073.80 / $14,125.38 / $38,018.94
| Facility | | $4,073.80 | $14,125.38 | $38,018.94 |