- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.11 / $5,754.40 / $14,454.40
| Facility | | $1,479.11 | $5,754.40 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $8,709.64 / $16,218.10
| Facility | | $3,235.94 | $8,709.64 | $16,218.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $1,862.09 / $5,011.87
| Facility | | $398.11 | $1,862.09 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $2,238.72 / $2,238.72 / $2,238.72
| Facility | 22 | $2,238.72 | $2,238.72 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $186.21 / $186.21 / $186.21
| Facility | AS | $186.21 | $186.21 | $186.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $2,818.38 / $9,772.37
| Facility | | $537.03 | $2,818.38 | $9,772.37 |