- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,778.28 / $4,897.79 / $11,748.98
| Facility | | $1,778.28 | $4,897.79 | $11,748.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $9,772.37 / $19,054.61
| Facility | | $3,311.31 | $9,772.37 | $19,054.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $457.09 / $3,311.31 / $13,803.84
| Facility | | $457.09 | $3,311.31 | $13,803.84 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $3,981.07 / $3,981.07 / $3,981.07
| Facility | 22 | $3,981.07 | $3,981.07 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $331.13 / $331.13 / $331.13
| Facility | AS | $331.13 | $331.13 | $331.13 |
- 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 |