- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $7,079.46 / $13,182.57
| Facility | | $1,148.15 | $7,079.46 | $13,182.57 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $7,762.47 / $7,762.47 / $7,762.47
| Facility | 22 | $7,762.47 | $7,762.47 | $7,762.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,762.47 / $10,232.93 / $19,952.62
| Facility | | $7,762.47 | $10,232.93 | $19,952.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $891.25 / $7,413.10
| Facility | | $524.81 | $891.25 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $912.01 / $912.01 / $912.01
| Facility | AS | $912.01 | $912.01 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,318.26 / $1,819.70
| Professional | | $1,096.48 | $1,318.26 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,466.84 / $5,495.41 / $8,912.51
| Facility | | $4,466.84 | $5,495.41 | $8,912.51 |