- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,897.79 / $15,135.61 / $31,622.78
| Facility | | $4,897.79 | $15,135.61 | $31,622.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,332.54 / $16,982.44 / $29,512.09
| Facility | | $9,332.54 | $16,982.44 | $29,512.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $562.34 / $3,090.30
| Facility | | $34.67 | $562.34 | $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
- Professional
- Modifier
- Low / Median / High Price
- $2,454.71 / $2,454.71 / $2,951.21
| Professional | | $2,454.71 | $2,454.71 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,778.28 / $2,454.71 / $3,890.45
| Facility | | $1,778.28 | $2,454.71 | $3,890.45 |
- 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 |