- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $5,623.41 / $15,488.17
| Facility | | $1,862.09 | $5,623.41 | $15,488.17 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $18,620.87 / $19,952.62 / $40,738.03
| Facility | 22 | $18,620.87 | $19,952.62 | $40,738.03 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $2,398.83 / $5,623.41 / $6,309.57
| Facility | 52 | $2,398.83 | $5,623.41 | $6,309.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $12,022.64 / $22,908.68
| Facility | | $4,570.88 | $12,022.64 | $22,908.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $6,456.54 / $19,054.61
| Facility | | $1,862.09 | $6,456.54 | $19,054.61 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $3,801.89 / $3,801.89 / $3,801.89
| Facility | 22 | $3,801.89 | $3,801.89 | $3,801.89 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $2,570.40 / $2,570.40 / $2,570.40
| Facility | 52 | $2,570.40 | $2,570.40 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $323.59 / $323.59 / $323.59
| Facility | AS | $323.59 | $323.59 | $323.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.83 / $6,760.83 / $15,135.61
| Facility | | $2,398.83 | $6,760.83 | $15,135.61 |