- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $2,951.21 / $4,897.79
| Facility | | $2,137.96 | $2,951.21 | $4,897.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,456.54 / $14,125.38 / $19,054.61
| Facility | | $6,456.54 | $14,125.38 | $19,054.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.46 / $1,995.26 / $2,238.72
| Facility | | $1,905.46 | $1,995.26 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $3,467.37 / $3,467.37
| Facility | | $758.58 | $3,467.37 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $4,168.69 / $4,168.69 / $4,168.69
| Facility | 22 | $4,168.69 | $4,168.69 | $4,168.69 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $346.74 / $346.74 / $346.74
| Facility | AS | $346.74 | $346.74 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $5,623.41 / $12,022.64
| Facility | | $1,023.29 | $5,623.41 | $12,022.64 |