- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,370.32 / $13,182.57 / $31,622.78
| Facility | | $5,370.32 | $13,182.57 | $31,622.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $562.34 / $3,311.31
| Facility | | $34.67 | $562.34 | $3,311.31 |
- 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
- Professional
- Modifier
- Low / Median / High Price
- $2,691.53 / $2,691.53 / $3,090.30
| Professional | | $2,691.53 | $2,691.53 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.46 / $2,691.53 / $4,265.80
| Facility | | $1,905.46 | $2,691.53 | $4,265.80 |
- 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 |