- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,265.80 / $9,772.37 / $24,547.09
| Facility | | $4,265.80 | $9,772.37 | $24,547.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,801.89 / $8,709.64 / $18,197.01
| Facility | | $3,801.89 | $8,709.64 | $18,197.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $575.44 / $1,023.29
| Facility | | $34.67 | $575.44 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $1,230.27 / $1,230.27 / $1,230.27
| Facility | 22 | $1,230.27 | $1,230.27 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $102.33 / $102.33 / $102.33
| Facility | AS | $102.33 | $102.33 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $776.25 / $912.01
| Professional | | $776.25 | $776.25 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $794.33 / $1,288.25
| Facility | | $588.84 | $794.33 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $19,498.45 / $25,703.96
| Facility | | $2,089.30 | $19,498.45 | $25,703.96 |