- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $4,786.30 / $12,022.64
| Facility | | $1,412.54 | $4,786.30 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,801.89 / $10,964.78 / $21,877.62
| Facility | | $3,801.89 | $10,964.78 | $21,877.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $426.58 / $2,041.74 / $8,511.38
| Facility | | $426.58 | $2,041.74 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $2,454.71 / $2,454.71 / $2,454.71
| Facility | 22 | $2,454.71 | $2,454.71 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $204.17 / $204.17 / $204.17
| Facility | AS | $204.17 | $204.17 | $204.17 |
- 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 |