- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $6,918.31 / $30,199.52
| Facility | | $851.14 | $6,918.31 | $30,199.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,456.54 / $18,620.87 / $43,651.58
| Facility | | $6,456.54 | $18,620.87 | $43,651.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.76 / $16,218.10 / $38,018.94
| Facility | | $2,187.76 | $16,218.10 | $38,018.94 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $1,258.93 / $1,258.93 / $1,258.93
| Facility | 22 | $1,258.93 | $1,258.93 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $208.93 / $208.93 / $208.93
| Facility | 53 | $208.93 | $208.93 | $208.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $11,220.18 / $32,359.37
| Facility | | $2,951.21 | $11,220.18 | $32,359.37 |