- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $5,370.32 / $13,803.84
| Facility | | $1,737.80 | $5,370.32 | $13,803.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $10,232.93 / $20,417.38
| Facility | | $3,630.78 | $10,232.93 | $20,417.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $457.09 / $2,951.21 / $12,022.64
| Facility | | $457.09 | $2,951.21 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $3,548.13 / $3,548.13 / $3,548.13
| Facility | 22 | $3,548.13 | $3,548.13 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $295.12 / $295.12 / $295.12
| Facility | AS | $295.12 | $295.12 | $295.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $2,884.03 / $10,000.00
| Facility | | $537.03 | $2,884.03 | $10,000.00 |