- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $3,235.94 / $5,754.40
| Facility | | $933.25 | $3,235.94 | $5,754.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,897.79 / $9,772.37 / $18,197.01
| Facility | | $4,897.79 | $9,772.37 | $18,197.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $1,698.24 / $1,698.24
| Facility | | $1,621.81 | $1,698.24 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $812.83 / $3,090.30
| Facility | | $489.78 | $812.83 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $3,715.35 / $3,715.35 / $3,715.35
| Facility | 22 | $3,715.35 | $3,715.35 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $309.03 / $309.03 / $309.03
| Facility | AS | $309.03 | $309.03 | $309.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $1,202.26 / $5,754.40
| Facility | | $371.54 | $1,202.26 | $5,754.40 |