- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $3,388.44 / $10,964.78
| Facility | | $977.24 | $3,388.44 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $11,481.54 / $28,840.32
| Facility | | $2,951.21 | $11,481.54 | $28,840.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $2,398.83 / $18,197.01
| Facility | | $1,202.26 | $2,398.83 | $18,197.01 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $1,548.82 / $1,548.82 / $1,548.82
| Facility | 22 | $1,548.82 | $1,548.82 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $128.82 / $128.82 / $128.82
| Facility | AS | $128.82 | $128.82 | $128.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,073.80 / $13,803.84 / $33,884.42
| Facility | | $4,073.80 | $13,803.84 | $33,884.42 |