- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $6,025.60 / $16,218.10
| Facility | | $1,202.26 | $6,025.60 | $16,218.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.99 / $2,884.03 / $3,630.78
| Facility | | $954.99 | $2,884.03 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $2,398.83 / $2,398.83 / $2,398.83
| Facility | 22 | $2,398.83 | $2,398.83 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $199.53 / $199.53 / $199.53
| Facility | AS | $199.53 | $199.53 | $199.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,495.41 / $11,748.98 / $22,908.68
| Facility | | $5,495.41 | $11,748.98 | $22,908.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,818.38 / $10,000.00 / $15,848.93
| Facility | | $2,818.38 | $10,000.00 | $15,848.93 |