- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $3,019.95 / $4,365.16
| Facility | | $933.25 | $3,019.95 | $4,365.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $8,511.38 / $12,022.64
| Facility | | $5,011.87 | $8,511.38 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39.81 / $1,819.70 / $1,819.70
| Facility | | $39.81 | $1,819.70 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $812.83 / $3,467.37
| Facility | | $489.78 | $812.83 | $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
- $371.54 / $1,174.90 / $5,754.40
| Facility | | $371.54 | $1,174.90 | $5,754.40 |