- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.83 / $7,943.28 / $16,595.87
| Facility | | $2,398.83 | $7,943.28 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $562.34 / $3,467.37
| Facility | | $34.67 | $562.34 | $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
- Professional
- Modifier
- Low / Median / High Price
- $1,905.46 / $1,905.46 / $2,290.87
| Professional | | $1,905.46 | $1,905.46 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $2,511.89 / $4,168.69
| Facility | | $1,698.24 | $2,511.89 | $4,168.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $478.63 / $6,165.95 / $8,912.51
| Facility | | $478.63 | $6,165.95 | $8,912.51 |